Lam Man Ching. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (leaves 101-114). / Abstracts in English and Chinese; appendices also in Chinese. / Chapter Chapter 1 --- Introduction and Literature Review / Chapter 1.1 --- General introduction of atopic dermatitis --- p.1 / Chapter 1.1.1 --- Definition and its nature --- p.1 / Chapter 1.1.2 --- Epidemiology and prevalence of atopic dermatitis --- p.1 / Chapter 1.1.3 --- Factors and triggers related to high risk of atopic dermatitis --- p.3 / Chapter 1.2 --- Pathogenesis of atopic dermatitis --- p.5 / Chapter 1.2.1 --- Nature of complexity of pathogenesis --- p.5 / Chapter 1.2.2 --- Role of T-helper cell in atopic dermatitis and its paradigm model --- p.5 / Chapter 1.2.3 --- Nature of immunoglobulin-E and its role in atopic dermatitis --- p.6 / Chapter 1.2.4 --- Chemokines in pathogenesis of atopic dermatitis: CTACK and TARC --- p.7 / Chapter 1.2.5 --- Role of antimicrobial peptides and innate immunity --- p.8 / Chapter 1.3 --- Measurements of atopic dermatitis severity and related quality of life impairment --- p.9 / Chapter 1.3.1 --- Scoring of atopic dermatitis severity and the SCO Ring Atopic Dermatitis Index --- p.9 / Chapter 1.3.2 --- Quality of life measurement --- p.9 / Chapter 1.3.3 --- The Children's Dermatology Life Quality Index (CDLQI) --- p.10 / Chapter 1.4 --- Pruritus in atopic dermatitis and its underlying mechanisms --- p.11 / Chapter 1.4.1 --- Introduction to pruritus --- p.11 / Chapter 1.4.2 --- Difference between pruritus and pain --- p.11 / Chapter 1.4.3 --- Pathogenesis and neuronal pathways of pruritus --- p.12 / Chapter 1.4.4 --- Neurogenic itch --- p.13 / Chapter 1.4.5 --- Role of histamines in pruritus of AD --- p.14 / Chapter 1.4.6 --- Substance-P --- p.14 / Chapter 1.4.7 --- Brain-derived neurotrophic factor and other recent mediators in pruritus --- p.15 / Chapter 1.5 --- "Scratching, nocturnal scratching and sleeping behavior in atopic dermatitis subjects and related research progress" --- p.16 / Chapter 1.5.1 --- Overview --- p.16 / Chapter 1.5.2 --- "Interrelationship between pruritus, scratching and sleep disturbance" --- p.17 / Chapter 1.5.3 --- Current methodologies in nocturnal scratching and sleep quality measurement --- p.18 / Chapter Chapter 2 --- Objectives --- p.25 / Chapter Chapter 3 --- Methodologies and Materials / Chapter 3.1 --- Validation of a new methodology /device --- p.27 / Chapter 3.1.1. --- Device selection --- p.27 / Chapter 3.1.2 --- Study design --- p.27 / Chapter 3.1.3 --- Validation of the Digitrac with laboratory markers --- p.29 / Chapter 3.1.4 --- Factor and statistical analysis --- p.31 / Chapter 3.2 --- Application of Digitrac in traditional Chinese herbal medication (TCHM / TCM) clinical trial --- p.32 / Chapter 3.2.1 --- Current AD treatment using corticosteroids and their drawbacks --- p.32 / Chapter 3.2.2 --- Recent trend on TCM treatment --- p.32 / Chapter 3.2.3 --- Study plan --- p.33 / Chapter 3.2.4 --- "Validation with laboratory markers, Staphylococcus aureus infection and statistical analysis" --- p.35 / Chapter 3.3 --- Application of Digitrac in a trial of 0.1% tacrolimus ointment in treatment of atopic dermatitis --- p.37 / Chapter 3.3.1 --- Topical immunomodulators as a treatment approach of AD --- p.37 / Chapter 3.3.2 --- Mechanism of tacrolimus in suppressing AD and pruritus --- p.37 / Chapter 3.3.3 --- Study plan --- p.39 / Chapter 3.4 --- Further application of Digitrac in pruritus of other medical fields --- p.41 / Chapter Chapter 4 --- Results and Discussions / Chapter 4.1 --- Digitrac validation --- p.52 / Chapter 4.1.1 --- General demographic background data --- p.52 / Chapter 4.1.2 --- Wrist activities --- p.53 / Chapter 4.1.3 --- Laboratory markers and factor analysis --- p.54 / Chapter 4.1.4 --- Interpretation of results --- p.55 / Chapter 4.1.5 --- Drawbacks of the validation --- p.58 / Chapter 4.1.6 --- Summary --- p.59 / Chapter 4.2 --- Digitrac in traditional Chinese herbal medication clinical trial --- p.68 / Chapter 4.2.1 --- General information --- p.68 / Chapter 4.2.2 --- "SCORAD, wrist activities and CDLQI" --- p.69 / Chapter 4.2.3 --- Laboratory findings --- p.70 / Chapter 4.2.4 --- Interpretation of results --- p.71 / Chapter 4.2.5 --- Safety of TCM use --- p.73 / Chapter 4.2.6 --- Summary --- p.74 / Chapter 4.3 --- Tacrolimus clinical trial --- p.81 / Chapter 4.4 --- Application of Digitrac in other areas of study --- p.90 / Chapter 4.4.1 --- Pemphigoid gestationis case study --- p.90 / Chapter 4.4.2 --- T-cell lymphoma case study --- p.92 / Chapter Chapter 5 --- Further Discussions and Conclusion --- p.98 / References --- p.101 / Appendices --- p.116

A atopia ou dermatite atópica é uma doença inflamatória pruriginosa, crônica e recorrente reconhecida como a segunda alergopatia mais comum, estando aquém apenas da dermatite alérgica à picada de pulgas. Esta doença é caracterizada pela presença exacerbada de prurido corpóreo, infringindo sofrimento ao paciente e desalentando seu proprietário. A busca a uma boa \"qualidade de vida\" está sendo cada vez mais demandada pelos proprietários de animais alergopatas ou portadores de outras doenças crônicas. Por se tratar de uma doença de longo decurso, o tratamento com glicocorticóides pode causar diversos efeitos colaterais, além de doenças mais graves como diabetes melitus e hiperadrenocorticismo iatrogênico. Como alternativa ao tratamento de cães atópicos, a ciclosporina (CsA) acaba tornando-se uma boa opção terapêutica. A CsA inibe as funções das células que iniciam a resposta imunológica (células de Langerhans e linfócitos) e das células que efetuam a resposta alérgica (mastócitos e eosinófilos) e, também, diminui a liberação de histamina e de várias citocinas. Os objetivos do presente estudo incluíram: análise da eficácia da CsA na redução de lesões corpóreas e do prurido com auxílio do CADESI-03 (Olivry et al.,2007) e de duas escalas de prurido corpóreo; detecção de ocorrência de eventuais efeitos adversos (tegumentares ou sistêmicos) decorrentes da terapia imunomodulatória através da realização de hemograma, função renal, função hepática e mensuração da pressão arterial; avaliação e monitoramento da qualidade de vida de 21 animais atópicos tratados com ciclosporina (5 mg/Kg, SID durante 60 dias) com auxílio de uma escala validada para cães. A CsA mostrou-se eficaz no tratamento da dermatite atópica canina pois reduziu as lesões corpóreas em 70% após 60 dias de terapia. Nesse mesmo período ocorreu redução da intensidade do prurido corpóreo em 52,6%, avaliado através da escala numérica verbal; e observou-se redução significativa na escala qualitativa de prurido corpóreo (Hill, 2002; modificada), uma vez que os níveis máximos de prurido (\"três\" e \"quatro\") quase não foram observados após a terapia imunomodulatória. Os efeitos adversos observados foram relacionados a distúrbios gastrintestinais e, ocorreram com maior freqüência nos primeiros 15 dias de tratamento. Alterações laboratoriais não foram observadas. Os animais portadores de dermatite atópica apresentaram melhora no escore de qualidade de vida em 32%. A CsA mostrou-se eficaz no tratamento da dermatite atópica canina. / Atopic dermatitis (AD) is an inflammatory, pruritic and chronic allergic skin disease. It´s recognized as the second most common allergic skin disease of dogs after flea allergy. Pruritus is the predominant sign of canine AD affecting a variety of areas of the body, leading to intense suffering to the animal and its owner. \"Quality of life\" (QL) is being much more requested from owner of animals with allergic skin diseases or with any kind of chronic disease. The long-term use of glucocorticoids therapy can be devastating because of its inumerous adverse effects and secondary diseases like diabetes mellitus and iatrogenic hiperadrenocorticism. Cyclosporine (CsA) has been considered a good therapeutic option in the treatment of canine atopic dermatitis. It inhibits the activation of cells that initiate cutaneous immune response (Langerhans\' cells and lymphocytes) and cells that mediate allergic reactions (mast cell and eosinophils). It also decreases histamine and other citocines release. The objectives of this study included: analysis of the efficacy of CsA in reducing skin lesions and pruritus of 21 atopic dogs using CADESI-03 (Olivry ey al., 2007) and two scales to quantify levels of body itching; detection of any possible adverse effects (dermatologic or systemic) secondary to immunomodulatory therapy, by performing complete blood count, renal and hepatic function and measurement of blood pressure; evaluation and monitoring QL from dogs treated with CsA (5 mg/Kg, SID during 60 days) with a validated scale; This immunomodulatory therapy was considered an effective treatment for atopic dogs because it reduced skin lesions in 70% after 60 days of therapy. During that period there was a reduction of body itching in 52,6% by verbal numeric scale, and there was significant reduction on qualitative scale of body itching (Hill, 2002; modified), since maximum levels of pruritus (\"three\" and \"four\") were hardly observed after immunomodulatory therapy. Gastrointestinal disorders were observed and appeared most often in the first 15 days of therapy. Laboratory abnormalities were not detected. The quality of life of these atopic dogs treated with CsA for 60 days was improved by 32%. CsA was effective and safe in the treatment of canine atopic dermatitis.

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2016-04-07T15:40:50Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) DAYANNE MOTA VELOSO BRUSCKY DISSERTAÇÃO 2015.pdf: 1467970 bytes, checksum: fee0da8b1c22b7ab32211b2ce92d54d9 (MD5) / Made available in DSpace on 2016-04-07T15:40:50Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) DAYANNE MOTA VELOSO BRUSCKY DISSERTAÇÃO 2015.pdf: 1467970 bytes, checksum: fee0da8b1c22b7ab32211b2ce92d54d9 (MD5) Previous issue date: 2015-05-29 / CNPq / A dermatite atópica acomete em torno de 10% da população pediátrica no mundo e causa importante interferência negativa na qualidade de vida relacionada à saúde dos pacientes e seus familiares principalmente relacionada ao prurido. É recomendada a utilização de pelo menos dois instrumentos para medir adequadamente este sintoma e, no Brasil, dispomos atualmente apenas da escala visual analógica. O objetivo deste estudo foi realizar a adaptação transcultural e validação para português (cultura brasileira) da Itch Severity Scale, instrumento para medir a gravidade de prurido. Trata-se de estudo metodológico de validação de instrumento. Baseado nos protocolos propostos por Beaton et al. (2010) e Reichenheim e Moraes (2007) para obter as equivalências conceitual, de itens, semântica, operacional e de mensuração. Participaram do estudo 7 alergologistas, 3 professores de inglês, 1 professor de linguística, 1 professor com experiência em validação de instrumento, 42 responsáveis por portadores de dermatite atópica entre 02 a 18 anos incompletos de idade e 42 responsáveis por crianças de mesma faixa etária sem doença cutânea pruriginosa. Resultados da escala foram comparados com gravidade da dermatite atópica e controle da doença, e entre os dois grupos. Da população selecionada, 98,8% participaram e 100% das questões da escala foram respondidas. Houve clareza das questões maior que 90%. A Escala de Gravidade de Prurido mostrou forte correlação positiva com a gravidade da dermatite atópica (índice de Pearson 0,74 p<0,001) e boa correlação com o controle da dermatite (coeficiente de correlação ponto-bisserial 0,65 p<0,001). Foi demonstrada ótima consistência interna (alfa de Cronbach 0,96) e adequada reprodutibilidade pela concordância do teste e reteste (coeficiente de correlação intraclasse variando de 0,89 a 0,99 com IC95% e p<0,001. A Escala de Gravidade de Prurido (ISS-Ped) apresentou-se viável, válida e confiável, podendo ser utilizada no Brasil para avaliar a gravidade do prurido em crianças e adolescentes com dermatite atópica, permitindo comparações na prática clínica e entre pesquisas de diferentes centros. / Atopic dermatitis affects around 10% of the pediatric population in the world and has important negative impacts the quality of life related to health of patients and their families particularly related to the itch. It is recommended to use at least two instruments to properly measure this symptom, and in Brazil, we currently only visual analogue scale. The aim of this study was to adapt cross-culturally and validate an instrument to measure the severity of itching, the Itch Severity Scale, into Brazilian Portuguese. It is a methodological instrument validation study. Based on the protocols proposed by Beaton et al. (2010) and Reichenheim and Moraes (2007) was obtained the conceptual, item, semantic, operational and measurement equivalences. Seven allergists, 3 English teachers, one professor of linguistics, one teacher with experience in instrument validation, 42 parents of children with atopic dermatitis between 02-18 years of age-old and 42 parents of children of the same age group without itchy skin disease. Scale results were compared with severity of atopic dermatitis and disease control, and between the two groups. In the sample, 98.8% participated and 100% of the scale of the questions were answered. There was clear understanding > 90% of the questions. The Pruritus Severity Scale showed a strong positive correlation with the severity of atopic dermatitis (Pearson index 0.74 p <0.001) and good correlation with the control dermatitis (correlation coefficient 0.65 bisserial point p <0.001). Excellent internal consistency was demonstrated (Cronbach's alpha 0.96) and adequate reproducibility for the test and retest agreement (intraclass correlation coefficients ranging from .89 to 0.99 with 95% CI p <0.001. The Escala de Gravidade de Prurido (ISS-Ped) proved to be feasible, valid and reliable and can be used in Brazil to assess the severity of itching in children and adolescents with atopic dermatitis, allowing comparisons in clinical practice and research between different centers.

A atopia ou dermatite atópica é uma doença inflamatória pruriginosa, crônica e recorrente reconhecida como a segunda alergopatia mais comum, estando aquém apenas da dermatite alérgica à picada de pulgas. Esta doença é caracterizada pela presença exacerbada de prurido corpóreo, infringindo sofrimento ao paciente e desalentando seu proprietário. A busca a uma boa \"qualidade de vida\" está sendo cada vez mais demandada pelos proprietários de animais alergopatas ou portadores de outras doenças crônicas. Por se tratar de uma doença de longo decurso, o tratamento com glicocorticóides pode causar diversos efeitos colaterais, além de doenças mais graves como diabetes melitus e hiperadrenocorticismo iatrogênico. Como alternativa ao tratamento de cães atópicos, a ciclosporina (CsA) acaba tornando-se uma boa opção terapêutica. A CsA inibe as funções das células que iniciam a resposta imunológica (células de Langerhans e linfócitos) e das células que efetuam a resposta alérgica (mastócitos e eosinófilos) e, também, diminui a liberação de histamina e de várias citocinas. Os objetivos do presente estudo incluíram: análise da eficácia da CsA na redução de lesões corpóreas e do prurido com auxílio do CADESI-03 (Olivry et al.,2007) e de duas escalas de prurido corpóreo; detecção de ocorrência de eventuais efeitos adversos (tegumentares ou sistêmicos) decorrentes da terapia imunomodulatória através da realização de hemograma, função renal, função hepática e mensuração da pressão arterial; avaliação e monitoramento da qualidade de vida de 21 animais atópicos tratados com ciclosporina (5 mg/Kg, SID durante 60 dias) com auxílio de uma escala validada para cães. A CsA mostrou-se eficaz no tratamento da dermatite atópica canina pois reduziu as lesões corpóreas em 70% após 60 dias de terapia. Nesse mesmo período ocorreu redução da intensidade do prurido corpóreo em 52,6%, avaliado através da escala numérica verbal; e observou-se redução significativa na escala qualitativa de prurido corpóreo (Hill, 2002; modificada), uma vez que os níveis máximos de prurido (\"três\" e \"quatro\") quase não foram observados após a terapia imunomodulatória. Os efeitos adversos observados foram relacionados a distúrbios gastrintestinais e, ocorreram com maior freqüência nos primeiros 15 dias de tratamento. Alterações laboratoriais não foram observadas. Os animais portadores de dermatite atópica apresentaram melhora no escore de qualidade de vida em 32%. A CsA mostrou-se eficaz no tratamento da dermatite atópica canina. / Atopic dermatitis (AD) is an inflammatory, pruritic and chronic allergic skin disease. It´s recognized as the second most common allergic skin disease of dogs after flea allergy. Pruritus is the predominant sign of canine AD affecting a variety of areas of the body, leading to intense suffering to the animal and its owner. \"Quality of life\" (QL) is being much more requested from owner of animals with allergic skin diseases or with any kind of chronic disease. The long-term use of glucocorticoids therapy can be devastating because of its inumerous adverse effects and secondary diseases like diabetes mellitus and iatrogenic hiperadrenocorticism. Cyclosporine (CsA) has been considered a good therapeutic option in the treatment of canine atopic dermatitis. It inhibits the activation of cells that initiate cutaneous immune response (Langerhans\' cells and lymphocytes) and cells that mediate allergic reactions (mast cell and eosinophils). It also decreases histamine and other citocines release. The objectives of this study included: analysis of the efficacy of CsA in reducing skin lesions and pruritus of 21 atopic dogs using CADESI-03 (Olivry ey al., 2007) and two scales to quantify levels of body itching; detection of any possible adverse effects (dermatologic or systemic) secondary to immunomodulatory therapy, by performing complete blood count, renal and hepatic function and measurement of blood pressure; evaluation and monitoring QL from dogs treated with CsA (5 mg/Kg, SID during 60 days) with a validated scale; This immunomodulatory therapy was considered an effective treatment for atopic dogs because it reduced skin lesions in 70% after 60 days of therapy. During that period there was a reduction of body itching in 52,6% by verbal numeric scale, and there was significant reduction on qualitative scale of body itching (Hill, 2002; modified), since maximum levels of pruritus (\"three\" and \"four\") were hardly observed after immunomodulatory therapy. Gastrointestinal disorders were observed and appeared most often in the first 15 days of therapy. Laboratory abnormalities were not detected. The quality of life of these atopic dogs treated with CsA for 60 days was improved by 32%. CsA was effective and safe in the treatment of canine atopic dermatitis.

Orientador: Luciana Patrícia Fernandes Abbade / Resumo: O prurido urêmico é uma complicação frequente em pacientes renais crônicos, com impacto na qualidade de vida. Sua etiopatogênese é multifatorial e as evidências para o tratamento com emolientes, anti-histamínicos orais e drogas de ação no sistema nervoso central, como a gabapentina, são limitadas. Objetivos: 1- verificar a prevalência de prurido urêmico e seus fatores associados; 2- avaliar a eficácia na redução do prurido urêmico com a terapia tópica com cold cream após 15 dias e 3-comparar a eficácia e segurança da gabapentina versus dexclorfeniramina na redução do prurido urêmico em um período de 21 dias. Métodos: A pesquisa foi realizada entre abril de 2014 a fevereiro de 2016. Inicialmente para atender ao objetivo 1, foi realizado estudo transversal e prospectivo com pacientes em hemodiálise (etapa 1). Os dados foram obtidos por meio de prontuário eletrônico e pela aplicação de questionário estruturado. Os pacientes que relataram prurido foram convidados a participar da etapa 2 para atender ao objetivo 2, sendo este uma série de casos com seguimento longitudinal não-comparativo, no qual os pacientes receberam cold cream para uso por 15 dias. Foram avaliados a intensidade do prurido através da Escala Visual Analógica (EVA), qualidade de vida (DLQI), número de topografias corporais afetadas, período do prurido e relatório de efeitos adversos. Ao final desta fase, para atingir o objetivo 3, os pacientes (60) que ainda se queixavam de prurido de qualquer intensidade iniciara... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Uremic pruritus is a frequent complication in chronic renal patients, with an impact on quality of life. Its etiopathogenesis is multifactorial and as evidence for treatment with emollients, oral antihistamines and drugs with central nervous system action such as gabapentin are limited. Objectives: 1- to verify the prevalence of UP and its associated factors; 2- evaluate the effectiveness in reduction of uremic pruritus with topical therapy with cold cream after 15 days and 3- evaluate the efficacy and safety of gabapentin vs. dexchlorpheniramine in reducing the uremic pruritus after 21 days. Methods: The study was carried out between April 2014 and February 2016. Initially to reach objective 1, a cross-sectional and prospective study was performed with patients undergoing hemodialysis (stage 1). The data were obtained by electronic medical record and by the application of a structured questionnaire. Patients who reported pruritus were invited to participate in stage 2 to reach objective 2, a series of cases with non-comparative longitudinal follow-up, in which the patients received cold cream for apply for 15 days. The intensity of pruritus was evaluated by the Visual Analogue Scale (VAS), and also the quality of life questionnaire (DLQI), number of affected topographies, pruritus period and adverse effects were assessed. At the end of this phase, to reach the objective 3, patients (60) with any intensity of pruritus were included in stage 3, where they were randomized to re... (Complete abstract click electronic access below) / Doutor

Uremic pruritus (UP) arises in end-stage renal disease (ESRD) and is not relieved by proper dialysis. While the pathogenesis of UP is not well understood, UP responds poorly to anti-histamines. We performed a case-control study to test if cutaneous protease-mediated, non-histamine itch is augmented in UP, and if UP is associated with altered epidermal and/or papillary dermal innervation. We recruited 12 hemodialysis subjects with ESRD-specific itch (cases) (Visual Analogue Scale (VAS)-average itch in the preceding week, 78/100), and 13 age- and sex-matched hemodialysis subjects without pruritus (controls) (VAS- average itch in the preceding week, 0/100; p<0.0001 cases vs. controls). Cowhage spicule-induced itch was induced in the back where all subjects exhibited itch, and the entire duration of itch was measured with the general Labeled Magnitude Scale. Subsequently, a punch biopsy was taken from this sensory-tested skin and multi-label immunohistochemistry was performed to measure epidermal and papillary dermal innervation. In cases vs. controls, cowhage-induced area under the curve (AUC) for itch was significantly larger (median, 25%–75%: 175.4, 101.0–252.2 vs. 42.4, 24.0–160; p=0.04) as was perceived peak itch intensity (53.6, 53.3–78.9 vs. 34.2, 20.9–55.6; p=0.02). Cases showed a significant reduction in papillary dermal nerve length (PDNL)/mm epidermis (2295, 1659–2970 vs. 2909, 2228–3523; p=0.003), resulting from the loss of papillary dermal (PD)-calcitonin gene related peptide (CGRP) (+) nerves (p<0.0001), with preservation of %PD-substance P (+) nerves (p=0.1) and intraepidermal nerve fiber density (p=0.1). VAS-average itch in the preceding week negatively correlated with PDNL/mm epidermis (correlation coefficient (CC)=-0.53, p=0.003) and %PD-CGRP (+) nerves (CC=-0.37, p=0.03). Cowhage-induced AUC-itch negatively correlated with %PD-CGRP nerves only in cases (CC=-0.40, p=0.02). Our data suggest augmented protease-dependent signaling contributes to UP and indicate a mechanism for how PD-CGRP (+) nerve loss contributes to UP and augmented cowhage-itch: loss of an afferent skin-derived itch-inhibition signal to the spinal cord dorsal horn. / 2016-10-02T00:00:00Z

Bakgrund: Kronisk njursvikt innebär att njurens funktioner gradvis minskar och blir nedsatta över tid, vilket kräver dialysbehandling i flera omgångar. Några av symtomen som kan uppstå i samband med kronisk njursvikt är bland annat klåda. Uremisk klåda kan besväras av både fysiskt och psykiskt då det bidrar till sår, ökad trötthet, försämrad livskvalitet. Lidande och obehag som orsakade av uremisk klåda kan ytterligare leda till depression och ångest. Det är därför viktigt att sjuksköterskor kan bemöta och hjälpa patienter som lider av uremisk klåda att lindra symtomen. Syfte: Syftet var att beskriva sjuksköterskors omvårdnadsåtgärder för att lindra uremisk klåda vid kronisk njursvikt Metod: Litteraturöversikten med tolv vetenskapliga artiklar. Databaserna PubMed och CINALH complete användes. Artiklarna analyserades med hjälp av Fribergs analysmodell. Resultat: I resultatet framkom fem teman; (1) Aromaterapi, (2) Termisk terapi, (3) Akupressur, (4) Krämer och (5) Övriga metoder. Dessa fem teman har visat vara effektiva för att lindra uremisk klåda. Slutsats: Sammanfattningsvis har aromaterapi, termisk terapi, akupressur, krämer och övriga omvårdnadsåtgärder visat sig verkande lindrande på uremisk klåda. Genom att tillämpa dessa omvårdnadsåtgärder kan det ytterligare bidra till bättre sömnkvalitet samt livskvalitet för patienterna som lider av uremisk klåda. Dessutom är omvårdnadsåtgärder kostnadseffektiva alternativ gentemot medicinska behandlingen. / Background: Chronic kidney failure means that the kidney's functions gradually decrease and become impaired over time, which requires dialysis treatment several rounds. Some of the symptoms that can occur in connection with chronic kidney failure is itching. Uremic itching can be troublesome both physically and psychologically as it contributes to ulcers, increased fatigue and reduced quality of life. Pain and discomfort caused by uremic pruritus can further lead to depression and anxiety. Therefore, it is necessary that nurses can address and help patients that are suffering from uremic pruritus to relieve the symptoms. Aim: The aim was to describe nurses care measure to treat pruritus in patients with chronic kidney failure. Method: The litterature review based on twelve scientific articles. The databases Pubmed and CINALH complete were used. The scientific articles were analyzed using Friberg´s model. Results: The results showed five themes; (1) Aromatherapy, (2) Thermal therapy, (3) Acupressure, (4) Creams and (5) Other methods. These five themes have been shown to be effective in relieving uremic pruritus. Conclusion: In conclusion, aromatherapy, thermal therapy, acupressure, creams and other methods have been shown to be working in treating uremic pruritus. By applying these nursing interventions can it further contribute to better quality of sleep and quality of life for patients that are suffering from uremic pruritus. Furthermore, are nursing interventions cost-effective alternatives to medical treatment.

No / This review focuses on treatment targets for the most common inflammatory skin diseases, eczema and psoriasis with an emphasis on cytokines expressed in the uppermost layer of the skin which is easily accessible for diagnostic and therapeutic approaches. Recently, a significant body of research has highlighted the influence of the skin barrier and the patients’ microbiome on skin inflammatory responses and we will comment on their impact on mediator regulation. Itch is a prominent dermatology symptom which is influenced by cytokines and can via itch–scratch cycle impact on the skin barrier and mediator expression associated with damage. Taking the contribution of pruritus and superficial skin damage into account, we address cytokines as targets for stratified treatment approaches in subgroups of eczema and psoriasis.

Chronic itch has a significant impact on quality of life for millions of patients worldwide, on a level comparable to that of chronic pain. Yet, although there are a host of effective drugs available for pain, there are no therapies that specifically target chronic itch. Current experimental approaches to investigate the pathogenesis of chronic pruritus and to test novel therapeutic agents are largely limited to rodent models. However, rodent models display significant dermatological, neurophysiological, and immunological differences from humans with chronic itch. The disadvantages of the current rodent paradigms call for the design of a valid primate model of chronic itch. For four years, we have monitored scratching behavior in a primate colony (n=35) of Cynomolgus macaques (Macaca fascicularis) suffering from idiopathic chronic itch. By comparing molecular and genetic analyses of the primates’ skin to their quantified scratching behavior, we attempted to characterize the underlying mechanisms of chronic itch in this model. Furthermore, the expression of itch-related proteins was examined in both the primate model and in humans with pruritic diseases. The first aim of the study was to characterize the underlying molecular and genetic basis of chronic itch in the primate model. We were able to distinguish specific peripheral targets related to pruritus by correlating the genetic and protein expression results to the primates’ scratching severity. In Aim 1a, RNA-sequencing was performed on skin biopsies from the primates to identify differentially expressed genes in pruritic, lichenified versus non-pruritic, non-lichenified skin. These results were then correlated to the quantified primate scratching behavior. This led to the identification of over 400 genes that were differentially expressed in the skin based on scratching intensity. Many of these differentially expressed transcripts were associated with sensory nerve fibers, keratinocytes, mast cells, or lymphocytes. Selected genes that were overexpressed and correlated to itch intensity were then targeted for immunohistochemical and proteomic analysis in Aim 1b. Immunohistochemical examination of the primate skin biopsies revealed that histamine levels were not elevated in primates that exhibited increased scratching behavior. However, mast cells containing tryptase were significantly increased in the skin of primates with severe scratching as compared to primates with mild scratching. The increased levels of gastrin-releasing peptide and substance P in lichenified skin were also found to be correlated to the primates’ scratching behavior. Of note, transient receptor potential channels V1, V3, and A1 were increased in the epidermis of primate skin, but the numbers of TRPV1+ and TRPA1+ nerve fibers were not significantly different between lichenified and non-lichenified skin. Transcriptome analysis of the opioid receptors and their ligands showed that primates with severe scratching behavior had a significant imbalance between the µ- and κ-opioid receptors and ligands. The µ-opioids had upregulated gene expression, while the κ-opioids were downregulated. In Aim 2, to further characterize this primate model of chronic itch, we compared immunohistochemical results from the primate studies to human findings. Lesional and non-lesional skin biopsies from patients with atopic dermatitis, psoriasis, and cutaneous T-cell lymphoma underwent immunohistochemical analysis in order to reveal the similarities and differences between the primate model and different types of chronic itch in humans. As in the primate model, substance P was found to be increased in the skin of lesional atopic and psoriasis skin. Additionally, similar to primate skin, human atopic and psoriatic skin had high levels of tryptase and its receptor in the epidermis. While IL-31 was only slightly elevated in primates, patients with cutaneous T-cell lymphoma or atopic dermatitis showed a significant correlation between itch severity and IL-31 levels. In conclusion, our primate model displayed expression patterns of many endogenous pruritogens and receptors that were similar to those of humans with atopic dermatitis or psoriasis. While the primate model did not completely mimic these specific pruritic diseases, the overlap of pruritic components suggests a commonality of signaling pathways across several different chronic itch states. The similarity of this primate model to human disease offers the combined advantages of experimental modeling and long-term behavioral follow-up. / Biomedical Sciences

The intertwined relationship between physical and psychological problems is a topic of much interest in the rehabilitation of severely injured patients, e.g. after a burn. The present study aims at gaining further knowledge concerning the impact of psychological factors and psychiatric morbidity on short and long-term adaptation after burn injury. Outcome was assessed for three main areas: pruritus, return to work and psychiatric health. Three separate samples of previous or current adult patients treated at the Uppsala Burn Unit during different time periods: 1980-1995 (n=248), 1996-2000 (n=86), and 2000-2005 (n=73), were assessed. Chronic burn-related pruritus is more common than previously reported and psychological factors such as anxiety-related personality traits and coping are significantly associated with its presence. Only a small group of former patients with work-related accidents were not working an average of nine years after injury. The unemployed reported more pain and worse perceived health, particularly in psychosocial domains. Returning to work was explained by both injury severity and personality characteristics. Those who were not working had lower health-related quality of life and poorer traumarelated physical and psychological health, and more pain. Preburn psychiatric morbidity is high in a lifetime perspective. Two thirds of the sample had at least one disorder according to the Structured Clinical Interview for DSM-IV Axis I disorders. Affective disorders were especially highly represented. A logistic regression showed that having a history of preburn disorders was associated with a higher risk of both PTSD and depression one year after the injury. In this material it was actually uncommon for a patient without a preburn psychiatric history to develop postburn psychiatric symptomatology. The results have strengthened the overall model for adaptation after burn injury by showing that psychological factors and psychiatric history are important moderators of the adaptation process after the injury.