In clinic studies, altered hypothalamic-pituitary-adrenal (HPA) axis function has been associated with fibromyalgia, a syndrome characterised by chronic widespread body pain. These results may be explained by the associated high rates of psychological distress and somatisation. We address the hypothesis that the latter, rather than the pain, might explain the HPA results. A population study ascertained pain and psychological status in subjects aged 25 to 65 years. Random samples were selected from the following three groups: satisfying criteria for chronic widespread pain; free of chronic widespread pain but with strong evidence of somatisation ('at risk'); and a reference group. HPA axis function was assessed from measuring early morning and evening salivary cortisol levels, and serum cortisol after physical (pain pressure threshold exam) and chemical (overnight 0.25 mg dexamethasone suppression test) stressors. The relationship between HPA function with pain and the various psychosocial scales assessed was modelled using appropriate regression analyses, adjusted for age and gender. In all 131 persons with chronic widespread pain (participation rate 74%), 267 'at risk' (58%) and 56 controls (70%) were studied. Those in the chronic widespread pain and 'at risk' groups were, respectively, 3.1 (95% CI (1.3, 7.3)) and 1.8 (0.8, 4.0) times more likely to have a saliva cortisol score in the lowest third. None of the psychosocial factors measured were, however, associated with saliva cortisol scores. Further, those in the chronic widespread pain (1.9 (0.8, 4.7)) and 'at risk' (1.6 (0.7, 3.6)) groups were also more likely to have the highest serum cortisol scores. High post-stress serum cortisol was related to high levels of psychological distress (p = 0.05, 95% CI (0.02, 0.08)). After adjusting for levels of psychological distress, the association between chronic widespread pain and post-stress cortisol scores remained, albeit slightly attenuated. This is the first population study to demonstrate that those with established, and those psychologically at risk of, chronic widespread pain demonstrate abnormalities of HPA axis function, which are more marked in the former group. Although some aspects of the altered function are related to the psychosocial factors measured, we conclude that the occurrence of HPA abnormality in persons with chronic widespread pain is not fully explained by the accompanying psychological stress.
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Two-third of the cases of HD may be diagnosed early in the neonatal period with varied symptoms like severe, continuous constipation with intermittent diarrhea and rarely with life-threatening complication such as enterocolitis [8]. Antenatal diagnosis of HD has been attempted unsuccessfully with positive predictability of around 15 % [4]. Belin et al. did a prospective study of approximately 15,000 pregnancies for prenatal ultrasound identification of colonic dilatation; out of 13 suspected cases of distension, 7 were found to be normal, 2 had imperforate anus, 3 had meconium ileus and 1 had malrotation [4]. Even though nomograms for the gestation specific diameter for descending colon and rectal are available, still ultrasound modality is not able to predict accurately, HD and imperforate anus [9]. Apart from noninvasive ultrasound, prenatal diagnosis of HD has been attempted by measuring amniotic fluid disaccharidase activity in the amniotic fluid, but without much success [10].
There are many treatment options for rosacea, such as topical metronidazole, azelaic acid cream, and non-irritating benzoyl peroxide; or systemic oral antibiotics, including tetracyclines, doxycycline, and minocycline. However, there are needs for other alternatives because of antibiotic resistance, irritation after the use of topic treatments[38], and the unlikely reduction of telangiectasia and centrofacial erythema[43][44]. Intense pulsed light (IPL) can successfully treat the clinical manifestations of rosacea that fail to respond to medical therapies, resolving telangiectasia and erythema, though longterm outcomes are less certain [45]. IPL is a relatively new technology that has been developed for treating vascular and pigmented lesions. It emits polychromatic light in millisecond pulse duration for delivering selective energy to target blood vessels[46], which is the target of rosacea treatment[47]. IPL has shown benefits treating facial rosacea, especially by improving the dysfunction of the meibomian glands and dry eye that these patients usually present[15][16][17][18][19][20][13]. The clinical improvement gets reflected by a decrease in symptoms due to MGD, tear film abnormality, and tear inflammatory markers[13]. 2ff7e9595c
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