What is the best treatment of resistant chronic urticaria to antihistamines and antileukoterianes?

My patient is a 27 year old female whit a history of 3 year chronic spontaneous urticaria. She went under treatment with antihistamines (first and second generation both), prednisone, colchicine, cyclosporine and also antidepressants like sertraline. Non of the treatments above were responsive.

I believe the patient suffers from depression and OCD and she has a phobia of HPV infection since she underwent surgery due to the past HPV infection. I would be grateful for any helpful information and recommendations.

The consensus at the allergy meetings seems to be heading in the direction of antihistamines not being that helpful for itching in atopic dermatitis, but literature supporting either position is sparse. Is there data out there that hasn't been published that actually shows it doesn't help?

I am a Brazilian psychiatrist with a master degree in preventive medicine. This year I will coordinate an academic ambulatory for medical students. I would like to teach deprescribing in psychiatry. The students are in the final year of medicine degree, and they will spend one month in this ambulatory. The ambulatory is part of a primary care setting which don’t have psychiatrists or other specialists. So, my major difficult is how to select patients? Which patients would benefit of this approach? Anyone has previous experience or suggestion??

Thank you!

Many efforts are spent to prevent, treat and stop COVID-19 spread.

but I think these efforts are fragmentary and not organized.

there is no platform for a scientific collaboration that could shorten the time of interesting findings, some nations hide some facts are a privilege of authorship or for other political reasons.

I think that all countries should a global platform for scientific collaboration.

Personally I have some ideas that could be proposed for the treatment of COVID-19 based on scientific facts but with the innovative mode of application, how and where can I try to apply them?

All nations should avoid wasting their time to find a solution for COVID-19 without international collaboration.

Ventilator is running out of supply under COVID-19, especially severely ill patients require non-invasive or even invasive ventilator support.

When there is outbreak of COVID-19 locally, physicians are facing the difficulties to choose between different patients for the allocation of limited medical resources.

Is there any simple way to turn something on hand to a usable ventilation machine? No matter household electronic gadgets, e.g. fan, vacuum cleaner, or existing medical equipment.

A hospital-acquired infection (HAI), also known as a nosocomial infection, is an infection that is acquired in a hospital or other health care facility. To emphasize both hospital and nonhospital settings, it is sometimes instead called a health care–associated infection (HAI or HCAI).

1) Does transfer from community hospital to tertiary center for definitive surgical management result in higher mortality rate versus patients in the city?

2) Are the patients who are rurally based experiencing delays to hip fixation compared to urban patients?

Patients: 1241 patients total. 714 patients from the city compared to 527 patients who were transferred in from rural community hospitals.

Mortality: Power 0.8, alpha 0.05, anticipated incidence of mortality in rural group 20% vs 10% in urban group

-199 patients required in each group to achieve the above?

Surgery within 48hrs: Power 0.8, alpha 0.05, anticipated incidence of mortality in rural group 70% vs 90% in urban group

-62 patients sample size required to achieve the above?

Main Outcome: Groups were compared with respect to mortality within 12 months of hip surgery and time to surgery. Subgroup analysis of rural patients based on distance from tertiary centre and mortality / achieving the benchmark of surgical management in 48 hours.

It's 99 days since the first case of COVID-19 in Hong Kong, and we are welcoming the 5th days of 0 new cases of COVID-19 following a week of <10 cases per day.

How should we define the end of a local endemic?

How long should the latent period be defined?

When is it safe to resume social activities?

Should territory wide screening of asymptomatic people be done before declaring the end of endemic?