Oxygen desaturation occurs during sleep in severe chronic obstructive pulmonary disease (COPD), especially during rapid eye movement (REM) sleep, due to hypoventilation and ventilation-perfusion mismatching, but the possible contribution of airflow limitation is unclear.In a randomised, placebo-controlled, double-blind study of severe, stable COPD patients, the authors compared 4 weeks treatment with a long-acting inhaled anticholinergic agent (tiotropium), taken in the morning (tiotropium-AM), or in the evening (tiotropium-PM), on sleeping arterial oxygen saturation (Sa,O 2 ) and sleep quality. Overnight polysomnography was performed at baseline and after 4 weeks treatment. A total of 95 patients with awake resting arterial oxygen tension f9.98 kPa (75 mmHg) were randomised, with a mean age of 66.4 yrs and mean forced expiratory volume in one second (FEV1) of 32% predicted.A total of 80 patients completed the study, of which 56 fulfilled the polysomnographic criterion of at least 2 h sleep in both sleep study nights and represent the group analysed. Tiotropium significantly improved spirometry compared with placebo. Both tiotropium-AM and tiotropium-PM groups had higher Sa,O 2 during REM than placebo (z2.41% and z2.42%, respectively, and both pooled and tiotropium-PM groups had higher Sa,O 2 during total sleep time (z2.49% and z3.06%, respectively). Sleep can be associated with clinically important adverse effects in patients with chronic obstructive pulmonary disease (COPD), principally disordered gas exchange and disturbances in sleep quality [1]. Sleep-related hypoxaemia and hypercapnia are well recognised in such patients, particularly during rapid eye movement (REM) sleep, and may contribute to cardiac arrhythmias during sleep [2] and predispose to nocturnal death during exacerbations [3]. The principal mechanism of disordered gas exchange during sleep is the physiological hypoventilation that is a normal feature of sleep, which has a disproportionate effect in hypoxaemic patients because of their position on the oxyhaemoglobin dissociation curve [4]. In addition, the physiological reduction in accessory muscle contribution to breathing, particularly during REM sleep, results in a decreased functional residual capacity, which leads to worsening ventilation-to-perfusion relationships, and further aggravates hypoxaemia [5]. Whether the severity of airflow limitation directly contributes to the degree of hypoventilation and/or oxygen desaturation is unclear, but cholinergic mechanisms could play a role in increasing airflow obstruction, since cholinergic tone has a normal circadian rhythm with higher levels during the sleeping hours [6].Hypoxaemia during sleep is easily corrected by supplementary oxygen [7,8], although whether this improves sleep quality is less clear [7][8][9][10]. An alternative approach would be to ameliorate some of the factors contributing to hypoxaemia during sleep described above, and a previous study of ipratropium, a short-acting anticholinergic bronchodilator, has shown im...

Previous studies on the association of smoking with acne vulgaris have reported conflicting results. The objective of this study was to investigate such an association. Our setting was three primary care practices in Hong Kong and one primary care practice in India. Patient characteristics in all four practices are similar. All medical records in these practices incorporate a section in which the smoking habits of each patient is routinely documented. We searched our database and retrieved 632 records of patients with acne seen in the previous 5 years. We also retrieved 632 records of age- and sex-matched controls. Fifty-three out of 379 male patients with acne and 25 out of 379 male controls were smokers (P = 0.001; OR, 2.3; 95% CI, 1.4-3.8). Six out of 253 female patients with acne and three out of 253 female controls were smokers (OR, 2.0; 95% CI, 0.5-9.4). We conclude that smoking is likely to bear a positive correlation with acne for men. Our numbers are too small for a definite conclusion to be drawn for females.

Tiotropium therapy has improved health outcomes in COPD patients in primary care settings. A 6 weekly PRP did not give any additional benefits in patients already given tiotropium.

Objectives/Methods: Although photodermatoses are common skin diseases, epidemiological data are lacking. In the framework of the European project SUNALL (http://www.sunall.net) we performed a survey in indoor workers (mainly hospital staff) on prevalence, signs, symptoms and treatment of photodermatoses (sun allergies) using a standardised questionnaire within Europe. Results: In 6 centres distributed from the Mediterranean to Scandinavia, the data of 6866 participants were analysed. 18% of them answered that they do get an itching rash/ abnormal skin after sun exposure (a so-called sun allergy), which does not fit the criteria of a sunburn. In 29% the photodermatoses have been confirmed by a physician (55% dermatologists). Women are nearly three times more often affected than men (23% vs. 9%). Comparing the different centres we found the following lifetime prevalence rates for photodermatoses: Athens (Greece) men 15%/women 26%, Besanç on (France) 5%/21%, Heidelberg (Germany) 9%/29%, Leiden (Netherlands) 7%/26%, Manchester (Great Britain) 9%/26% and Turku (Finland) 2%/14%.Increasing pigmentation correlates with a decrease of photodermatoses (overall prevalence skin type I 32%, II 26%, III 14%, IV 9%). About half of the photodermatoses have been treated mostly with sun block cream (65% of those treated). Other treatments: steroid cream (42%), phototherapy (9%) or steroid tablets/injections (7%). Only 54% get their rash during springtime but over 90% during sunny holidays. 93% get itching during the rash. 25% of people with photodermatoses report a reduction of their quality of life. Conclusions: Our data document the high prevalence of photodermatoses in Europeans. Interestingly, we found no increase in regions far away from the equator, but we found a more pronounced sex ratio.

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