Zoon's Vulvitis and Coexisting Lichen Planus: A Rare Vulval Dermatosis.

This case report describes Zoon's vulvitis or plasma cell vulvitis (PCV) with coexisting lichen planus (LP) treated with methotrexate. PCV is a rare, chronic, benign idiopathic inflammatory condition of the vulvar mucosa, characterized by a bright-red, chronic lesion of mucosa. Typically, it presents as atrophic, shiny, red plaques that can affect any part of the vulva and can spread symmetrically and bilaterally with the propensity of chronicity and gradual coalescence.

What makes an athlete? A scoping review: Assessing the use of the word athlete with anterior cruciate ligament rehabilitation review studies. Is there a standard?

The term athlete does not currently have an agreed definition or standardized use across the literature. We analyzed the use of the term "athlete" amongst review studies specific to Anterior Cruciate Ligament (ACL) rehabilitation to investigate if the term was justified in its use. A comprehensive review of a database was performed to identify review papers which used the term "athlete" in the title, and which were related to ACL rehabilitation and surveillance.

Unstable bradycardia induced by posterior nasal packing: a rare activation of the Trigeminocardiacreflex.

A woman in her 40s presented to the emergency department with epistaxis. Anterior nasal packing was unsuccessful in achieving haemostasis. After the exchange of devices and insertion of a posterior nasal pack, the patient developed a junctional rhythm and progressively unstable bradycardia.

Higher Ustekinumab Levels in Maintenance Therapy are Associated with Greater Mucosal Healing and Mucosal Response in Crohn's Disease: An Experience of 2 IBD Centers.

Background: Ustekinumab (UST), a human monoclonal antibody that binds the p40 subunit of interleukin 12 (IL-12) and IL-23, is licensed for induction and maintenance therapy of moderate to severe inflammatory bowel disease (IBD). To date, there is limited data published on any potential association between ustekinumab serum trough levels and mucosal healing in order to guide treatment strategies and appropriate dosing.

Aim: This study aims to identify a relationship between maintenance ustekinumab serum trough levels and mucosal healing and/or response in patients with Crohn's disease in an observational cohort study.

Use of digital measurement of medication adherence and lung function to guide the management of uncontrolled asthma (INCA Sun): a multicentre, single-blinded, randomised clinical trial.

Background: The clinical value of using digital tools to assess adherence and lung function in uncontrolled asthma is not known. We aimed to compare treatment decisions guided by digitally acquired data on adherence, inhaler technique, and peak flow with existing methods.

Methods: A 32-week prospective, multicentre, single-blinded, parallel, randomly controlled trial was done in ten severe asthma clinics across Ireland, Northern Ireland, and England.

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study.

Background: Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.

Methods: This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014.

Sarcopenia and Inflammatory Bowel Disease: A Systematic Review.

Background: Sarcopenia is associated with increased morbidity and mortality in oncologic and transplant surgery. It has a high incidence in chronic inflammatory states including inflammatory bowel disease (IBD). The validity of existing data in IBD and of sarcopenia's correlation with surgical outcomes is limited.

Lisinopril in elderly patients with hypertension. Long term effects on renal and metabolic function.

The efficacy and tolerability of lisinopril administered once daily were evaluated in a 12-week open study of 60 elderly patients aged between 65 and 85 years (mean 75 years) with essential hypertension. Mean sitting blood pressure was reduced from 190/106 +/- 6.3/1.

Cardioprotection and antihypertensive therapy. Are beta-blockers the only effective therapy?

Hypertension is a major risk factor for stroke and coronary heart disease and this increases with increasing age. It is a chronic disease which affects a quarter of the adult population. On its own or in conjunction with other risk factors, especially cigarette smoking, hypertension is associated with serious morbidity and high mortality.

Antihypertensive and renal effects of lisinopril in older patients with hypertension.

The antihypertensive efficacy and safety of lisinopril were assessed in 60 older patients with a mean age of 75 years (range, 65 to 85 years) in a 12-week open study. Mean ( +/- SEM) blood pressure while sitting was reduced from 190/106 +/- 3.3/1.

Pharmacokinetics of amlodipine in renal impairment.

The pharmacokinetics of amlodipine was studied in 27 subjects with renal function ranging from normal to dialysis-dependent. Amlodipine (as a single 5-mg capsule) was administered once daily for 14 days and its plasma concentrations were measured by gas chromatography during and after treatment. Renal impairment had little or no effect on the pharmacokinetics of amlodipine.