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Background & Aims: Endoscopic retrograde cholangiopancreatography (ERCP)-related adverse events (AEs) are associated with morbidity, mortality, and healthcare expenditure. We aimed to assess incidences and comparisons of ERCP AEs., Methods: We included studies performed after 2000 reporting on ERCP AEs from database inception through March 12, 2024. Outcomes included pancreatitis, bleeding, cholangitis, cholecystitis, perforation, and death. DerSimonian and Laird random effects meta-analyses were performed to calculate incidences of AEs. Subgroup and pairwise meta-analyses were performed. Meta-regression was performed on median recruitment year to assess temporal trends in pancreatitis incidence., Results: A total of 380 studies were included. The incidence of death attributable to ERCP was 0.2% (95% confidence intervals, CI, 0.1-0.3%, I 2 44%, n=47,258) in all-comers. The overall incidence of pancreatitis was 4.6% (95% CI 4.0-5.1%, I 2 96%, n=293,378) among all-comers and 6.5% (95% CI 5.9-7.1%, I 2 89%, n=88,809) among first-time patients. Pancreatitis incidence remained stable between 2000-2023 (average annual percent change 0.06, 95%CI -0.27 to 0.39). The overall incidences of the following AEs for all-comers were: bleeding (1.5%, 95% CI 1.2-1.7%, I 2 93%, n=229,655), cholangitis (2.5%, 95%CI 1.9-3.3%, I 2 96%, n=121,619), cholecystitis (0.8%, 95%CI 0.5-1.2%, I 2 39%, n=7,799), and perforation (0.5%, 95%CI 0.4-0.6%, I 2 90%, n=306,378)., Conclusions: ERCP-associated AEs remain common. Incidence of post-ERCP pancreatitis remained static despite improvements in techniques, prevention, and recognition. These results are important to patients, endoscopists, and policy makers to inform consent and to encourage implementation of available risk mitigation strategies., (Copyright © 2024 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Coronavirus disease 2019 (COVID-19) pneumonia has had catastrophic effects worldwide. Radiology, in particular computed tomography (CT) imaging, has proven to be valuable in the diagnosis, prognostication, and longitudinal assessment of those diagnosed with COVID-19 pneumonia. This article will review acute and chronic pulmonary radiologic manifestations of COVID-19 pneumonia with an emphasis on CT and also highlighting histopathology, relevant clinical details, and some notable challenges when interpreting the literature., Competing Interests: Disclosure Nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

In the present study, a total of 102 samples were collected from chickens of different flocks, died due to suspected colibacillosis. Bacteriological and PCR methods were applied to detect avian pathogenic Escherichia coli (APEC). Phenotypic antimicrobial resistance (AMR) was determined by disk diffusion method. Extended spectrum beta lactamases (ESBL) detection was carried out via PCR by targeting bla TEM, bla SHV, blaOXA, and  bla CTX-M groups 1, 2, and 9. Genes of eight virulence factors and class I integrons were also detected by PCR using gene specific primers. Culture, microscopic, biochemical tests and PCR recognised 69/102 (67.64%) samples as E. coli . Phenotypic AST revealed higher resistance against fluoroquinolone antibiotics, i.e ., enrofloxacin (72.46%), levofloxacin (69.56%) & ciprofloxacin (66.66%), followed by amoxyclav (63.77%) and tetracycline (59.42%). Six isolates were found as pan-drug-resistant E. coli . A total of 48 (69.56%) and 7 (10.14%) isolates were positive for the presence of bla TEM and bla CTX-M-G9 genes, respectively, whereas 2 (2.90%) isolates each were found positive for bla SHV, blaOXA,  and bla CTX-M-G1 genes. Among APEC associated virulence genes, iss (79.71%) was the most predominant, followed by tsh (50.72%), ast (30.43%), cvaf (26.08%), pap (23.18%), vat (8.69%) and stx -1 (1.44%). Thirty-two isolates harboured class I integrons, either with or without ESBL genes. Conclusively, the isolates under study showed pan and multiple-drug resistance, specifically against fluoroquinolone drugs. ESBL production was mediated principally through bla TEM and bla CTX-M-G9. Multiple virulence factors, toxins, and carriage & spread factor render these as zoonotically potential pathogens for humans., Supplementary Information: The online version contains supplementary material available at 10.1007/s12088-023-01132-2., Competing Interests: Conflict of interestThe authors declare no conflicts of interest related to this article., (© Association of Microbiologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Background: PRDM12 polyalanine tract expansions cause two different disorders: midfacial toddler excoriation syndrome (MiTES; itch with normal pain sensation associated with 18 homozygous alanines (18A); and congenital insensitivity to pain (CIP) with normal itch associated with 19 homozygous alanines (19A). Knowledge of the phenotype, genotype and disease mechanism of MiTES is incomplete. Why 18A vs. 19A PRDM12 can cause almost opposite phenotypes is unknown; no other polyalanine or polyglutamine tract expansion disease causes two such disparate phenotypes., Objectives: To assess the genotype and phenotype of nine new, nine atypical and six previously reported patients diagnosed with MiTES., Methods: Using cell lines with homozygous PR domain zinc finger protein 12 (PRDM12) containing 12 alanines (12A; normal), 18A (MiTES) and 19A (CIP), we examined PRDM12 aggregation and subcellular localization by image-separation confocal microscopy and subcellular fractionation Western blotting., Results: MiTES presents in the first year of life; in all cases the condition regresses over the first decade, leaving scarring. The MiTES phenotype is highly distinctive. Features overlapping with PRDM12 CIP are rarely found. The genotype-phenotype study of the PRDM12 polyalanine tract shows that having 7-15 alanines is normal; 16-18 alanines is associated with MiTES; 19 alanines leads to CIP; and no clinically atypical cases of MiTES had a polyalanine tract expansion. PRDM12 aggregation and subcellular localization differed significantly between 18A and normal 12A cell lines and between 18A and 19A cell lines. MiTES is a new protein-aggregation disease., Conclusions: We provide diagnostic criteria for MiTES and improved longitudinal data. MiTES and CIP are distinct phenotypes, despite their genotypes varying by a single alanine in the PRDM12 polyalanine tract. We found clear distinctions between the cellular phenotypes of normal, MiTES and CIP cells. We hypothesize that the developmental environment of the trigeminal ganglion is unique and critically sensitive to pre- and postnatal levels of PRDM12., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Association of Dermatologists.)

Cementless implant use continues to increase primarily due to increased numbers of younger and obese patients opting for primary total knee arthroplasty (TKA). Given the increased use of cementless implants, the purpose of this study was to evaluate the midterm clinical performance of cementless TKA using a highly porous tibial baseplate compared with its cemented counterpart of the same system. We conducted a retrospective case-control study of 400 patients undergoing primary TKA that included 200 patients with cementless components matched for age and body mass index (BMI) to 200 patients with cemented implants of the same implant design with a 5-year follow-up. We evaluated clinical results, complications, revisions, and overall survivorship between the cohorts. Statistical analysis was performed using student t -test and chi-square analysis. There was no statistical difference in age (64.3 vs. 64.3 p  = 0.81), BMI (34 vs. 33.1 p  = 0.19), preoperative Knee Society Score (KSS) function (41 vs. 32.3 p  = 0.22), and preoperative KSS knee score (39.2 vs. 38.3 p  = 0.54) between the cementless and cemented cohorts, respectively. The cementless group had seven revisions, while the cemented group had nine revisions ( p  = 0.609). The cementless group had one revision due to aseptic loosening versus five in the cemented group ( p  = 0.09). Postoperative 5-year KSS knee scores were 92.84 versus 91.75 ( p  = 0.386) and function scores were 81.81 versus 69.65 ( p  = 0.00004) in the cementless and cemented groups, respectively. The cementless group had survivorship of 96.5% for all-cause revision compared with 95.5% in the cemented group at 5-year follow-up ( p  = 0.60). Cementless TKA using a highly porous tibial baseplate showed excellent midterm results with one case of aseptic loosening at 5-year follow-up and with similar Knee Society outcome scores and survivorship compared with the cemented group. Cementless TKA demonstrated noninferiority to cemented TKA and could be used as an alternative mode of fixation in patients opting for primary TKA. Additional long-term follow-up is needed to determine if cementless TKA can demonstrate improved survivorship over cemented TKA., Competing Interests: A.L.M. reports the following declarations: 1) Stryker: IP royalties, Paid consultant, Paid presenter or speaker, Research support; 2) Parvizi Surgical Innovations: Stock or stock options. All other authors have no declarations., (Thieme. All rights reserved.)

Background: Dermatology is an ideal specialty for artificial intelligence (AI)-driven image recognition to improve diagnostic accuracy and patient care. Lack of dermatologists in many parts of the world and the high frequency of cutaneous disorders and malignancies highlight the increasing need for AI-aided diagnosis. Although AI-based applications for the identification of dermatological conditions are widely available, research assessing their reliability and accuracy is lacking., Objective: The aim of this study was to analyze the efficacy of the Aysa AI app as a preliminary diagnostic tool for various dermatological conditions in a semiurban town in India., Methods: This observational cross-sectional study included patients over the age of 2 years who visited the dermatology clinic. Images of lesions from individuals with various skin disorders were uploaded to the app after obtaining informed consent. The app was used to make a patient profile, identify lesion morphology, plot the location on a human model, and answer questions regarding duration and symptoms. The app presented eight differential diagnoses, which were compared with the clinical diagnosis. The model's performance was evaluated using sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and F 1 -score. Comparison of categorical variables was performed with the χ 2 test and statistical significance was considered at P<.05., Results: A total of 700 patients were part of the study. A wide variety of skin conditions were grouped into 12 categories. The AI model had a mean top-1 sensitivity of 71% (95% CI 61.5%-74.3%), top-3 sensitivity of 86.1% (95% CI 83.4%-88.6%), and all-8 sensitivity of 95.1% (95% CI 93.3%-96.6%). The top-1 sensitivities for diagnosis of skin infestations, disorders of keratinization, other inflammatory conditions, and bacterial infections were 85.7%, 85.7%, 82.7%, and 81.8%, respectively. In the case of photodermatoses and malignant tumors, the top-1 sensitivities were 33.3% and 10%, respectively. Each category had a strong correlation between the clinical diagnosis and the probable diagnoses (P<.001)., Conclusions: The Aysa app showed promising results in identifying most dermatoses., (©Shiva Shankar Marri, Warood Albadri, Mohammed Salman Hyder, Ajit B Janagond, Arun C Inamadar. Originally published in JMIR Dermatology (http://derma.jmir.org), 02.07.2024.)

Vitiligo is an acquired depigmenting disorder due to the destructive loss of melanocytes, clinically presenting as hypopigmented or depigmented macules and/or patches. Many theories have been proposed to explain its etiopathogenesis among which cell-mediated immunity is one of the crucial links. Estimation of vitiligo activity and extent in a patient is important in tailoring an optimal treatment regimen. Interleukin-6 (IL-6) and high-sensitivity C-reactive protein (HsCRP) are sensitive indicators for systemic inflammation and are found to be relevant in determining vitiligo disease activity. This study was conducted to estimate serum levels of IL-6 and HsCRP in vitiligo patients and to correlate them with the disease activity and extent in order to assess if these serum markers serve as objective indicators of vitiligo disease activity. This was a hospital-based cross-sectional study of 58 vitiligo patients diagnosed clinically irrespective of age, gender, and any ongoing or past treatment. Disease activity and extent were calculated using the vitiligo disease activity (VIDA) score and vitiligo area severity index (VASI), respectively. Serum levels of IL-6 and HsCRP were obtained and their correlation with VIDA and VASI values were statistically analyzed. A weak negative statistically insignificant correlation was found between IL-6 and VIDA (P = 0.092). No correlation was found between VIDA and HsCRP (P = 0.998). A weak positive, statistically insignificant correlation was found between VASI and IL-6 as well as between VASI and HsCRP (P = 0.175 and P = 0.238, respectively). Although statistically insignificant, the patients who were not on immunosuppressive therapy showed higher mean values of IL-6 and HsCRP compared to those who were on immunosuppressive therapy. In contrast to the findings of previous studies, our study found a weak negative correlation between VIDA and IL-6 levels possibly attributable to the difference between the mean levels of IL-6 among the subgroups of patients who were, and were not on immunosuppressive therapy. The VIDA score and HsCRP levels did not show any statistical correlation. However, patients who were not on immunosuppressive therapy showed a higher albeit statistically insignificant mean value of HsCRP. Our observations suggest that any ongoing and/or treatment in the recent past, especially immunosuppressive therapy, and any co-morbidities should be essentially considered while investigating for sensitive serum markers of inflammation as determinants of vitiligo disease activity., Competing Interests: There are no conflicts of interest., (© 2024 Published by Scientific Scholar on behalf of Journal of Cutaneous and Aesthetic Surgery.)

Competing Interests: Conflict of Interest None declared.

Coronavirus disease 2019 (COVID-19) pneumonia has had catastrophic effects worldwide. Radiology, in particular computed tomography (CT) imaging, has proven to be valuable in the diagnosis, prognostication, and longitudinal assessment of those diagnosed with COVID-19 pneumonia. This article will review acute and chronic pulmonary radiologic manifestations of COVID-19 pneumonia with an emphasis on CT and also highlighting histopathology, relevant clinical details, and some notable challenges when interpreting the literature., Competing Interests: Disclosure Nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Competing Interests: There are no conflicts of interest.

Background and Aims: Given the underlying properties of cannabinoids, we aimed to assess associations between cannabinoid use and sedation requirements for esophagogastroduodenoscopy (EGD) and colonoscopy. Methods: A prospective cohort study was conducted at three endoscopy units. Adult outpatients undergoing EGD or colonoscopy with endoscopist-directed conscious sedation (EDCS) were given questionnaires on cannabinoid use and relevant parameters. Outcomes included intraprocedural midazolam, fentanyl, and diphenhydramine use, procedural tolerability, and adverse events. Multivariable logistic regression was performed to yield adjusted odds ratios (AORs) of outcomes. Results: A total of 419 patients were included. Baseline cannabinoid use was associated with high midazolam use, defined as ≥5 mg, during EGD (AOR 2.89, 95% confidence interval, CI: 1.19-7.50), but not during colonoscopy (AOR 0.89, 95% CI 0.41-1.91). Baseline cannabinoid use was associated with the administration of any diphenhydramine during EGD (AOR 3.04, 95% CI: 1.29-7.30) with a similar nonsignificant trend for colonoscopy (AOR 2.36, 95% CI: 0.81-7.04). Baseline cannabinoid use was associated with increased odds of requiring high total sedation, defined as any of midazolam ≥5 mg, fentanyl ≥100 mcg, or any diphenhydramine during EGD (AOR 3.72, 95% CI: 1.35-11.68). Cannabinoid use was not independently associated with fentanyl use, intraprocedural awareness, discomfort, or adverse events. Conclusions: Baseline cannabinoid use was associated with higher sedation use during endoscopy with EDCS, particularly with midazolam and diphenhydramine. Given increasingly widespread cannabinoid use, endoscopists should be equipped with optimal sedation strategies for this population. As part of the informed consent process, cannabis users should be counseled that they may require higher sedation doses to achieve the same effect.

In the present study, total of 32 ante-mortem (AM) samples (saliva = 18 and corneal smears = 14) from six animal species (cattle = 5; camel = 1; goat = 1; horse = 1; buffalo = 4; dog = 6) and 28 post-mortem (PM) samples of domestic (cattle = 6; camel = 1; goat = 1; buffalo = 5; dog = 7) and wild animals (lion = 4, mongoose = 2; bear = 1; leopard = 1) were examined for rabies diagnosis in Gujarat, India. Direct fluorescent antibody test (dFAT) and reverse transcriptase polymerase chain reaction (RT-PCR) were applied on AM samples, whereas along with dFAT and RT-PCR, histopathological examination, immunohistochemistry (IHC) and real time PCR (qPCR) were used for PM diagnosis. Nucleotide sequencing of full nucleoprotein (N) and glycoprotein (G) genes were carried out upon representative amplicons. In AM examination, 7/18 saliva and 5/14 corneal impressions samples were found positive in dFAT and 8/18 saliva samples were found positive in RT-PCR. In PM examination, 14/28 samples showed positive results in dFAT and IHC with unusual large fluorescent foci in two samples. In histopathology, 11/28 samples showed appreciable lesion and Negri bodies were visible in 6 samples, only. Out of 23 brain samples examined. 12 samples were found positive in N gene RT-PCR and qPCR, and 10 samples in G gene RT-PCR. Phylogenetic analysis of N gene revealed that test isolates (except sample ID: lion-1; lion, Gir) form a close group with sequence ID, KM099393.1 (Mongoose, Hyderabad) and KF660246.1 (Water Buffalo, Hyderabad) which was far from some south Indian and Sri Lankan isolates but similar to Indian isolates from rest of India and neighboring countries. In G gene analysis, the test isolates form a close group with sequence ID, KP019943.1., Supplementary Information: The online version contains supplementary material available at 10.1007/s12088-023-01126-0., Competing Interests: Conflict of interestThe authors declare no conflicts of interest., (© Association of Microbiologists of India 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Aims: The use of cementless total knee arthroplasty (TKA) components has increased during the past decade. The initial design of cementless metal-backed patellar components had shown high failure rates due to many factors. The aim of this study was to evaluate the clinical results of a second-generation cementless, metal-backed patellar component of a modern design., Methods: This was a retrospective review of 707 primary TKAs in 590 patients from a single institution, using a cementless, metal-backed patellar component with a mean follow-up of 6.9 years (2 to 12). A total of 409 TKAs were performed in 338 females and 298 TKAs in 252 males. The mean age of the patients was 63 years (34 to 87) and their mean BMI was 34.3 kg/m 2 (18.8 to 64.5). The patients were chosen to undergo a cementless procedure based on age and preoperative radiological and intraoperative bone quality. Outcome was assessed using the Knee Society knee and function scores and range of motion (ROM), complications, and revisions., Results: A total of 24 TKAs (3.4%) in 24 patients failed and required revision surgery, of which five were due to patellar complications (0.71%): one for aseptic patellar loosening (0.14%) and four for polyethylene dissociation (0.57%). A total of 19 revisions (2.7%) were undertaken in 19 patients for indications which did not relate to the patella: four for aseptic tibial loosening (0.57%), one for aseptic femoral loosening (0.14%), nine for periprosthetic infection (1.3%), one for popliteus impingement (0.14%), and four for instability (0.57%). Knee Society knee and function scores, and ROM, improved significantly when comparing pre- and postoperative values. Survival of the metal-backed patellar component for all-cause failure was 97.5% (95% confidence interval 94.9% to 100%) at 12 years., Conclusion: The second-generation cementless TKA design of metal-backed patellar components showed a 97.5% survival at 12 years, with polyethylene dissociation from the metal-backing being the most common cause of patellar failure. In view of the increased use of TKA, especially in younger, more active, or obese patients, these findings are encouraging at mean follow-up of seven years., Competing Interests: J. F. Baker reports research support to their institution from Zimmer Biomet, unrelated to this study. A. C. Jouflas reports support for attending meetings and/or travel from the University of Louisville Department of Orthopaedic Surgery, unrelated to this study. A. L. Malkani reports IP royalties, speaker and consultant honoraria, and research support from Stryker Orthopedics, and holds stock or stock options in Parvizi Surgical Innovation, outside the submitted work., (© 2023 The British Editorial Society of Bone & Joint Surgery.)

Hematological indices have long been used in a variety of conditions as indicators of systemic inflammation. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are inexpensive tools in predicting severity and disease activity in acute coronary syndrome, malignancy, coronavirus disease 2019 (COVID-19) illness, and other autoimmune conditions. Evidence suggests that such hematological indices can be used in various dermatoses as predictors of systemic inflammation, to assess the severity of the disease, prognosis, and treatment response., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Indian Dermatology Online Journal.)

Wheat is one among the significant crops for humans. Significant fungal illnesses of wheat are brought on by multiple pathogens. Wheat output could be enhanced by the early identification of wheat leaf disease. Thus, a novel hyperparameter tanh-based convolutional neural network (HT-CNN)-based wheat leaf disease prediction is proposed with its severity level. Here, initially, the red, green, and blue (RGB) images are converted into a hue saturation value (HSV) image. Next, the small probability space filtering is applied to the V component. Afterward, the contrast of the V component has been enhanced. The obtained HSV image is converted into the RGB image. Then, by employing weighted Canberra distance-based K-means (WCD-K means), the affected and normal regions are segmented. Next, the image is binarized. Afterward, for tracing a boundary around disease-affected region, the hex directional vertex chain code (Hex-D-VCC) is applied over the binarized image, and then the features are extracted. By employing baker's map-based Harris hawks optimization (BM-HHO), the optimal features are selected. For classifying disease, the selected features are further given into the HT-CNN, and the severity level is calculated to minimize the yield loss. As per the experimental result, the proposed model shows higher accuracy and efficacy when analogized to the other methods., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Heterotopic ossification (HO) is a pathologic bone formation in extra skeletal tissue and articular space. This was an objection to nailing of femur fractures across the knee; however, this has not been the case in many thousands of cases. Nonetheless, we present a patient in who placement of a retrograde nail resulted in calcification in the knee requiring excision., Case Presentation: A 42-year-old male presented to the clinic complaining of pain, popping, clicking, and mocking in the right knee, especially in the patellar region. Nine months prior he suffered an ipsilateral femur fracture that was treated with a retrograde intramedullary nail. X-ray and CT scan were used to confirm the presentation of a heterotopic bone mass in the Hoffa area of the right knee. The patient underwent an arthrotomy for excision of the bone mass. The bone mass was excised, but bone in the ACL was not removed. The patient experienced pain relief and improved range of motion following excision., Conclusion: Intraarticular heterotopic ossification is an infrequent event. We present a case of heterotopic ossification in the knee following retrograde nailing. The patient experienced improved symptoms and range of motion after excision of the intraarticular heterotopic bone mass., (© 2023. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Background: Preoperative planning is important for successful total hip arthroplasty (THA) and has been historically performed using acetate templates. Digital software templating has been adopted for evaluating implant size, position, and alignment. Commercial software can be expensive, but free programs exist. Detroit Bone Setter (detroitbonesetter.com, Detroit, MI) is a freely available templating program, but hasn't been validated. Our study reports this program's accuracy for templating THA., Methods: Sixty-five patients undergoing THA between 2017 and 2022 at 2 hospitals were included. All cases were templated by the senior author or orthopaedic trauma fellow prospectively or retrospectively in a blinded fashion. Direct anterior or posterior approaches were used based on attending surgeon's preference. A student's t-test was used to compare means of templated vs actual implant sizes of femoral and acetabular components., Results: There was no significant difference between implanted (mean [M] = 6.4, standard deviation [SD] = 2.0) and templated femoral component sizes (M = 5.7, SD = 2.1). There was a significant difference between implanted (M = 57.0, SD = 3.9) and templated acetabular component sizes (M = 53.4, SD = 3.0). Bland-Altman testing demonstrated femoral components with positive measurement bias of 0.62, indicating slight overestimation of implant size. Acetabular component size was overestimated with positive measurement bias of 3.6 mm., Conclusions: Detroit Bone Setter is advantageous as it is freely available and supports most major company implants. It accurately templated femoral component size but consistently overestimated acetabular component size by 3.6 mm. Further studies are needed prior to recommending its routine use for templating THA when other validated methods exist. It could be used with caution when no other methods are available., (© 2023 The Authors.)

Morbidly obese patients undergoing cemented primary total knee arthroplasty (TKA) can pose a challenging problem with implant survivorship due to greater stress at the cement-bone interface. With the advent of additive manufacturing (three-dimensional printing), highly porous implants are now readily available. The purpose of this study was to review the results of primary TKA in the morbidly obese (body mass index [BMI] ≥ 40) patient using a highly porous cementless tibial baseplate. This is a retrospective study of 167 TKAs in patients with morbid obesity undergoing primary cementless TKA with a minimum 5-year follow-up. A total of 6 patients died and 14 were lost to follow-up, leaving 147 TKAs in 136 patients with a mean follow-up of 66 months (range 60-79 months). The average age was 59 years (range 36-84 years) and average BMI was 45 kg/m 2 (range 39.5-63.9). Clinical results, patient-reported outcome measures, radiographs, and complications were reviewed. There were 9 failures requiring revision, including 3 for aseptic tibial loosening (2.0%), 2 for deep infection (1.4%), 2 for patellar resurfacing (1.4%), 1 for patella instability (0.7%), and 1 for extensor mechanism rupture (0.7%). Knee Society Score (KSS) improved from 48 to 90 at 2- and 5-year follow-up. KSS function score improved from 49 to 68 and 79 at 2- and 5-year follow-up, respectively. Survivorship with aseptic loosening as the endpoint was 98.0% at 5 years. Cementless TKA using a highly porous tibial baseplate in morbidly obese patients demonstrated excellent clinical results with 98% survivorship at 5 years and appears to offer durable long-term biologic fixation as an alternative to mechanical cement fixation in this challenging group of patients., Competing Interests: A.M. declares the following conflicts of interest: Journal of Arthroplasty: Editorial or governing board; Stryker: IP royalties; paid consultant; paid presenter or speaker; research support S.H. declares the following conflicts of interest: Orthopedics: Editorial or governing board SLACK Incorporated: Editorial or governing board; Stryker: IP royalties; Paid consultant; Paid presenter or speaker; Stock or stock Options; Thieme, Inc., Journal of Hip Surgery, Journal of Knee Surgery: Editorial or governing board; Thieme, Inc., Journal of Knee Surgery, Journal of Hip Surgery: Publishing royalties, financial or material support. The rest authors declare no conflict of interest., (Thieme. All rights reserved.)

Background: Historically, 1st generation metal-backed cementless patellar implants demonstrated high failure rates due to multiple factors. The 2nd generation cementless implants were developed with purported improvements in component design and polyethylene wear characteristics. This study evaluated clinical results of a current generation cementless metal-backed patellar implant with a minimum 5-year follow-up., Methods: One hundred and thirty-six primary total knee arthroplasties (TKAs) with metal-backed cementless patellae were compared to 183 cemented patellae with the same implant design. The cementless group mean age was 61 years (range, 40 to 81), mean body mass index (BMI) of 34.9 (range, 22.6 to 64.5), and mean follow-up of 10 years (range, 5 to 13). The cemented group mean age was 65 years (range, 32 to 89), mean BMI of 32.5 (range, 18.2 to 56.6), and mean follow-up of 10 years (range, 5 to 12). Significant demographic differences of age (P < .001), BMI (P < .01), and sex (P < .001) were found, with cementless patients being younger, heavier, and with more men., Results: There were no statistical differences in non-revision procedures (P = .214), TKA revisions (P = .639), patellar revisions (P = .151), and patellar aseptic loosening (P = .737). The 10-year survivorship of the cementless metal-backed patella was 95.9% with all-cause failure as the endpoint. The 10-year survivorship of the cemented patellar component was 98.9%., Conclusion: This study demonstrated noninferiority of a 2nd generation HA-coated cementless metal-backed patellar implant in primary TKA compared to cemented patellae with 10-year survivorship of 95.9%. Advances in implant design and polyethylene wear properties have led to improved clinical results with metal-backed patellar components in primary TKA., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Dermoscopy is a non-invasive diagnostic technique that provides an added advantage to the routine clinical diagnostic exercise. Role of dermoscopy in cutaneous small vessel vasculitis has not been explored well., Objective: This study was intended to delineate the dermoscopic features of cutaneous small vessel vasculitis and to correlate them with histopathological findings of the disease., Materials and Methods: This was a cross-sectional study involving 30 patients with cutaneous small vessel vasculitis confirmed by histopathology and direct immunofluorescence. In each patient, dermoscopic features of early/evolving and established lesions were recorded. Dermoscopic-histopathological correlation was assessed for established lesions., Results: On dermoscopy, the early/evolving lesions showed a dull red background in all the 30 (100%) patients, red globules in 8 (26.7%), and red dots in 4 (13.30%) patients. The established lesions showed red background in 28 (93.3%) patients, white and yellow structureless areas in 19 (63.33%) patients each, red globules in 18 (60%), and red dots in 16 (53.3%) patients. A statistically significant association between red globules and red blood cell extravasation was noted ( P -0.01). White and yellow structureless areas also showed a statistically significant association between sparse ( P -0.023) and dense ( P -0.007) perivascular infiltrates, respectively., Conclusion: Dermoscopy of cutaneous small vessel vasculitis exhibits fairly reliable and reproducible features correlating well with histopathological aspects of the disease. Hence, inclusion of dermoscopy in the clinical diagnostic protocol for cutaneous small vessel vasculitis is beneficial in complementing the clinical diagnosis and in differentiating from other inflammatory purpuras., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Indian Dermatology Online Journal.)

Competing Interests: There are no conflicts of interest.

Competing Interests: There are no conflicts of interest.

Competing Interests: There are no conflicts of interest.

Background: Artificial intelligence (AI) aims to create programs that reproduce human cognition and processes involved in interpreting complex data. Dermatology relies on morphological features and is ideal for applying AI image recognition for assisted diagnosis. Tibot is an AI app that analyzes skin conditions and works on the principle of a convolutional neural network. Appropriate research analyzing the accuracy of such apps is necessary., Objective: This study aims to analyze the predictability of the Tibot AI app in the identification of dermatological diseases as compared to a dermatologist., Methods: This is a cross-sectional study. After taking informed consent, photographs of lesions of patients with different skin conditions were uploaded to the app. In every condition, the AI predicted three diagnoses based on probability, and these were compared with that by a dermatologist. The ability of the AI app to predict the actual diagnosis in the top one and top three anticipated diagnoses (prediction accuracy) was used to evaluate the app's effectiveness. Sensitivity, specificity, and positive predictive value were also used to assess the app's performance. Chi-square test was used to contrast categorical variables. P<.05 was considered statistically significant., Results: A total of 600 patients were included. Clinical conditions included alopecia, acne, eczema, immunological disorders, pigmentary disorders, psoriasis, infestation, tumors, and infections. In the anticipated top three diagnoses, the app's mean prediction accuracy was 96.1% (95% CI 94.3%-97.5%), while for the exact diagnosis, it was 80.6% (95% CI 77.2%-83.7%). The prediction accuracy (top one) for alopecia, acne, pigmentary disorders, and fungal infections was 97.7%, 91.7%, 88.5%, and 82.9%, respectively. Prediction accuracy (top three) for alopecia, eczema, and tumors was 100%. The sensitivity and specificity of the app were 97% (95% CI 95%-98%) and 98% (95% CI 98%-99%), respectively. There is a statistically significant association between clinical and AI-predicted diagnoses in all conditions (P<.001)., Conclusions: The AI app has shown promising results in diagnosing various dermatological conditions, and there is great potential for practical applicability., (©Shiva Shankar Marri, Arun C Inamadar, Ajit B Janagond, Warood Albadri. Originally published in JMIR Dermatology (http://derma.jmir.org), 01.03.2023.)

Background: The management of nonhealing ulcers has been a major challenge clinically. Current therapies include debridement, offloading, etc., which show a poor response. Newer modalities include stem cells, platelet-derived growth factors, and fibrin glues, which reduce healing time. Platelets play a major role in wound healing through the secretion of growth factors, chemokines, etc. and have been an area of interest as a modality in regenerative medicine., Aims and Objective: The aim was to study the comparative efficacy of autologous platelet-rich fibrin (PRF) and platelet-rich plasma (PRP) as a regenerative medicine strategy for chronic cutaneous ulcers., Materials and Methods: Forty-four ulcers of duration greater than six weeks were enrolled for a comparative study comprising two groups, each divided either into group A receiving PRF dressings or group B receiving PRP dressing for six weeks. The ulcer evaluation was performed at baseline, each weekly dressing, and a two-week follow-up., Results: Primary efficacy was assessed by the percentage reduction in the volume of ulcers and re-epithelization at eight weeks. In total, 95.2% of ulcers in group A and 90.4% of ulcers in group B showed complete re-epithelization. One ulcer in group A and two ulcers in group B developed an infection. The recurrence of the ulcer was seen in four ulcers in the PRF group and three ulcers in the PRP group., Conclusion: Dressings done with PRF and PRP showed similar efficacy in the percentage reduction in the volume and re-epithelization of chronic cutaneous ulcers. Both dressings were associated with similar complications. PRF and PRP dressings provide a safe, efficacious, and inexpensive regenerative medicine strategy in the healing of chronic cutaneous ulcers., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Cutaneous and Aesthetic Surgery.)

Competing Interests: There are no conflicts of interest.

Competing Interests: There are no conflicts of interest.

The emergence of antimicrobial resistance among Staphylococcus spp. isolated from clinical cases of canines should be continuously monitored hence the present study was formulated to ascertain the antibiotypes and methicillin resistance in coagulase positive and coagulase negative staphylococci of canine skin and associated mucous membrane affections from a hot and dry region of India. A total of 165 clinical samples were collected and Staphylococcus aureus was identified by conventional bacteriological methods and PCR. Antibiotic susceptibility test was done against commercially available antibiotic impregnated discs as per Clinical and Laboratory Standards Institute (CLSI) method. Methicillin resistance was determined by plate methods and then via PCR of mecA gene. These 165 samples yielded, 88 (53.33%) isolates of genus Staphylococcus and 46 S. aureus and 51/88 (57.95%) isolates were coagulase positive staphylococci. Total 55 (62.5%) isolates showed susceptibility to Ceftriaxone/Sulbactum, 37 (42.05%) to Ciprofloxacin, 26 (29.55%) to Oxacillin, 24 (27.27%) to Penicillin, and 10 (11.36%) to Gentamicin. Total 21 methicillin-resistant S. aureus (MRSA) and 12 methicillin-resistant coagulase negative staphylococci (MRCoNS) were found on phenotypic basis whereas the mecA gene was detected in 6/21 MRSA and 2/12 MRCoNS isolates. Staphylococcus spp. showed increased level of resistance against commonly used antibiotics. The higher prevalence of methicillin resistance found with phenotypic methods than to mecA PCR indicates toward additional mechanisms responsible for emergence of MRS, especially in CoNS., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Competing Interests: Competing interests: None.

Hair loss is one of the most common post-covid symptoms observed during this severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Pro-inflammatory cytokines, direct viral effect on hair follicles, and microthrombi are thought to be the pathogenic factors considered. Information regarding time of onset and severity is similar to other infection-induced acute telogen effluvium. It is reasonable to think that the evolution and prognosis are similar, and therefore, even without any specific treatment, full recovery of lost hair is expected., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Indian Dermatology Online Journal.)

Background: The evolution in pulmonary arterial hypertension (PAH) management has been summarised in three iterations of the European Society of Cardiology/European Respiratory Society (ESC/ERS) guidelines. No study has assessed whether changes in management, as reflected in the changing guidelines, has translated to improved long-term survival in PAH., Methods: We performed a mixed retrospective/prospective analysis of treatment-naïve, incident PAH patients (n=392) diagnosed at three major centres in Canada from 2009 to 2021. Patients were divided into two groups based on their diagnosis date and in accordance with the 2009 and 2015 ESC/ERS guideline iterations. Overall survival was assessed based on date of diagnosis and initial treatment strategy ( i.e. monotherapy versus combination therapy)., Results: There was a shift towards more aggressive upfront management with combination therapy in Canada after the publication of the 2015 ESC/ERS guidelines (10.4% and 30.8% in patients from 2009 to 2015 and 36.0% and 57.4% in patients diagnosed after 2015 for baseline and 2-year follow-up, respectively). A key factor associated with combination therapy after 2015 was higher pulmonary vascular resistance (p=0.009). The 1-, 3- and 5-year survival rates in Canada were 89.2%, 75.6% and 56.0%, respectively. Despite changes in management, there was no improvement in long-term survival before and after publication of the 2015 ESC/ERS guidelines (p=0.53)., Conclusions: There was an increase in the use of initial and sequential combination therapy in Canada after publication of the 2015 ESC/ERS guidelines, which was not associated with improved long-term survival. These data highlight the continued difficulties of managing this aggressive pulmonary disease in an era without a cure., Competing Interests: Conflict of interest: J.G.E. Zelt has nothing to disclose. Conflict of interest: J. Sugarman has nothing to disclose. Conflict of interest: J. Weatherald reports grants, personal fees and nonfinancial support from Janssen Inc. and Actelion, personal fees and nonfinancial support from Bayer, personal fees from Novartis, outside the submitted work. Conflict of interest: A.C.R. Partridge has nothing to disclose. Conflict of interest: J. Liang has nothing to disclose. Conflict of interest: J. Swiston reports personal fees from Janssen J&J, outside the submitted work. Conflict of interest: N. Brunner reports personal fees from Janssen Pharmaceuticals, outside the submitted work. Conflict of interest: G. Chandy reports personal fees for advisory board work and consultancy from Bayer Pharmaceuticals, personal fees for advisory board work, lectures and consultancy from Janssen Pharmaceuticals, personal fees for advisory board work from Apotex, during the conduct of the study. Conflict of interest: D.J. Stewart reports other (equity) from Northern Therapeutics, outside the submitted work. Conflict of interest: V. Contreras-Dominguez has nothing to disclose. Conflict of interest: M. Thakrar reports grants from Reata Pharmaceuticals, outside the submitted work; and advisory board work for Janssen Pharmaceuticals. Conflict of interest: D. Helmersen reports grants from Gilead, Janssen and United Therapeutics, outside the submitted work. Conflict of interest: R. Varughese has nothing to disclose. Conflict of interest: N. Hirani reports grants (paid to institution) from Bayer, United Therapeutics and Northern Therapeutics, grants (paid to institution) and other (advisory board membership) from Actelion/Janssen, outside the submitted work. Conflict of interest: F. Umar has nothing to disclose. Conflict of interest: R. Dunne has nothing to disclose. Conflict of interest: C. Doyle-Cox has nothing to disclose. Conflict of interest: J. Foxall has nothing to disclose. Conflict of interest: L. Mielniczuk reports grants and personal fees for lectures from Janssen, grants from Bayer, outside the submitted work., (Copyright ©The authors 2022.)

Ipsilateral axillary lymphadenopathy is a well-documented finding associated with COVID-19 vaccination. Varying guidelines have been published for the management of asymptomatic patients who have a history of recent vaccination and present with incidental lymphadenopathy at screening mammography. Some experts recommend follow-up imaging, and others suggest that clinical management, rather than repeat imaging or biopsy, is appropriate. Symptomatic patients with lymphadenopathy and/or additional abnormal imaging findings should be treated differently depending on risk factors and clinical scenarios. Although ipsilateral lymphadenopathy is well documented, ipsilateral breast edema after COVID-19 vaccination has been rarely reported. The combination of ipsilateral lymphadenopathy and diffuse breast edema after COVID-19 vaccination presents a clinical management challenge because edema can obscure underlying abnormalities at imaging. For symptomatic patients with lymphadenopathy and associated breast parenchymal abnormality, prompt action is appropriate, including diagnostic evaluation and consideration of tissue sampling. This approach may prevent delays in diagnosis and treatment of patients with malignancy masked by symptoms from the vaccination.

Ras/mitogen-activated protein kinase pathway dysregulation results in a group of disorders, collectively termed as RASopathies. Neurofibromatosis type 1, Noonan syndrome, Noonan syndrome with multiple lentigines, Noonan syndrome/loose anagen hair, Legius syndrome, Costello syndrome, cardio-facio-cutaneous syndrome and capillary malformation-arteriovenous malformation are the well-recognized RASopathies. These are characterized by multi-organ tumours and hamartomas. Some other features in common are facial dysmorphism, skeletal abnormalities, congenital heart disease, neurocognitive abnormalities and risk of various solid-organ and haematological malignancies. Some of the RASopathies are heterogeneous, caused by several gene mutations resulting in variations in phenotypes and severity ranging from mild to fatal. Significant phenotypic overlaps among different disorders, often makes it difficult to pinpoint a clinical diagnosis. Specific cutaneous manifestations are present in some of the RASopathies and are often the earliest clinical signs/symptoms. Hence, dermatologists contribute significantly as primary care physicians by identifying disorder-specific cutaneous lesions. However, diagnostic work-up and management of these disorders are often multidisciplinary. Confirmation of diagnosis is possible only by genetic mapping in each case. Genetic counseling of the patients and the affected families is an important component of the management. The aim of this review is description of cutaneous manifestations of RASopathies in the background of multi-system involvement to enable dermatologists a comprehensive and logical approach to work up and diagnose such patients in the absence of facility for specific molecular testing.

Rationale and Objectives: We aim to compare Choose Your Own Adventure (CYOA) presentation format with linear case format as educational methods for teaching a radiology small group session to medical students., Materials and Methods: A radiology small group session was held for preclinical second-year medical students in the pulmonary course, whereby eight classrooms of students and eight radiology facilitators were each randomized to do either the linear case format or the nonlinear CYOA presentation format. All students in attendance were administered a survey at the end of the session, which assessed students' perceptions using five-point Likert-type questions. The survey also contained a four-question knowledge quiz on chest radiology. The facilitators were administered a qualitative survey as well. Between-group analyses were performed using Student's t-test., Results: Of the 144 students who attended the small group sessions, 143 students completed the survey (99.3%). The CYOA format group reported significantly greater engagement in the cases (4.5 ± 0.7 vs. 3.8 ± 0.7, p < 0.001), satisfaction with the format (4.6 ± 0.6 vs. 3.7 ± 0.9, p < 0.001), and enhancement of clinical decision making skills (4.5 ± 0.6 vs. 3.5 ± 0.9, p < 0.001). The linear format group reported a greater role for the facilitator to add value (4.6 ± 0.5 vs. 4.3 ± 1.1, p = 0.033). There was no significant difference between groups in performance on the knowledge quiz., Conclusion: Medical students reported higher satisfaction, engagement, and enhanced clinical decision making skills with the CYOA presentation method compared to linear case format for radiology small group learning., (Copyright © 2021 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

In this study, the impact of ozonation abetted with the citric acid pretreatment (OZCAP) method on fruit waste was investigated for ameliorating hydrogen production. Initially, the ozonation pretreatment (OZP) method was performed by varying ozone (O 3 ) dosage and disintegration time. At optimized conditions (O 3 dosage (0.04 g/g suspended solid; SS) and disintegration time (40 minutes)), 17.6% of liquefied organics emancipate rate (LER) and 13.5% of SS reduction were perceived. Further augmenting LER of fruit waste, OZCAP method was proceeded by varying citric acid dosage and disintegration time at an optimized OZP dosage (0.04 g/g SS). A higher LER (24.4%) and SS reduction (19%) were described at an optimal citric acid dosage (0.03 g/g SS) and disintegration time (20 minutes). Then, the hydrogen production potential of OZCAP, OZP and raw fruit waste were evaluated in which OZCAP method exhibited a higher cumulative hydrogen production (30 mL/g volatile solids). Energy valuation reveals that OZCAP method exhibited a net energy of 3.7 kWh/kg of fruit waste.

Competing Interests: There are no conflicts of interest.

Corona Virus Disease (COVID) 19 has shaken the earth at its root and the devastation has increased the diagnostic burden of radiologists by large. At this crucial juncture, Artificial Intelligence (AI) will go a long way in decreasing the workload of physicians working in the outbreak zone, aiding them to accurately diagnose the new disease. In this work, a hybrid Particle Swarm Optimization-Support Vector Machine based AI algorithm is deployed to analyze the Computed Tomography images automatically providing a high probability in determining the presence of pneumonia due to COVID19. This paper presents a model for training the system to segregate and classify the presence of pneumonia which will in turn save around 50% of the time frame for physicians. This will be especially useful in places of outbreaks where a team of people are working together with the aid of artificial intelligence and/or medical background. The AI incorporated system was distributed in all areas of across the globe. It has been observed that challenges such as data security, testing time effectiveness of model, data discrepancy etc. were positively handled using the deployed system. Moreover, since the AI integrated system identifies the infected patients immediately physicians can confirm the infection and segregate the patients at the right period. A total of 200 training cases have been observed of which 150 were identified to be infected. The proposed work shows specificity of 0.85, a sensitivity of 0.956 and an accuracy of 95.78%., Competing Interests: Conflict of interestNot applicable., (© Bharati Vidyapeeth's Institute of Computer Applications and Management 2022.)

Infectious bursal disease (IBD), caused by infectious bursal disease virus ( IBDV ), has recently been reported in chickens vaccinated with classical or intermediate types of vaccines from various regions of India due to the emergence of novel very virulent strains of infectious bursal disease virus (vvIBDV). In the present study, suspected samples of IBD were collected from poultry flocks of districts of Gujarat and Nagpur (Maharashtra), identified using PCR and grouped as per traditional and new genogrouping pattern. Out of 54 bursa samples, 21 (38.89%) yielded the expected amplicon of 743 bp (701-1444 bp), and were found positive for IBDV. Among these 21 positive flocks, 11 (52.38%) were already vaccinated. Upon nucleotide sequencing of amplicon and its deduction into amino acids, it was found that all the sequences of present study were related to vvIBDV according to old classification pattern. Considering the new genogrouping pattern, nine and four sequences of this study fell within G3a and G3b lineage, respectively. These sequences revealed important differences at key amino acid positions with respect to classical (G1 genogroup), variant (G2 genogroup) type of IBDV and classical vaccines. Further divergence from prototypic vvIBDV strains was revealed as, D-N at 212 position (N = 9) and 279 position (N = 1). In sequences from Maharashtra (group 2 of G3a lineage), occurrence of V instead of P/T/A at 222 position was recorded as a novel and conspicuous substitution in the immunodominant peak A of VP2 hypervariable region. Additional changes at 270 (3 sequences) and 272 positions (4 sequences) could be attributed to reverse mutation or recombination with vaccine strains. In conclusion, both point mutation and genetic reassortment with intermediate type of vaccines were found to be responsible for generation of novel vvIBDV strains in this area which belonged to G3a and G3b genogroups., Competing Interests: Conflicts of interestAll authors declare no conflict of interest., (© Indian Virological Society 2021.)

Skin lesions occurring over the knuckles can be a primary or characteristic manifestation of a disorder. Characteristic knuckle lesions may also be important cutaneous features of various internal disorders when they serve as useful clinical pointers, as well as may speak of the disease severity in certain instances. Furthermore, knuckle lesions also speak of various external factors as the underlying cause of the disease/lesions, such as trauma - occupational or otherwise, and contact dermatitis. Although knuckles essentially imply dorsal aspect of the metacarpophalangeal joints, many of the lesions described as those 'involving the knuckles' are seen over the proximal and/or less frequently, the distal interphalangel joints as well. This review presents a compilation of various inherited and acquired dermatoses and dermatological manifestations of various internal disorders associated with different forms of knuckle lesions., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Indian Dermatology Online Journal.)

Every citizen responds to governments' protocols when imposed during a time of crisis. Yet occasionally they counter-react in a way that is not intended by the government, contributing to the cobra effect. The Government of Tamil Nadu, India implemented the double lockdown protocol in the pursuit of restraining the spread of covid -19. Nevertheless, the protocol leads to unanticipated consequences on the spread of novel coronavirus. The thrust of the study is to demonstrate the unprecedented consequences of double lockdown on the growth rate of covid-19 cases, instead of flattening the curve and subsequently reveal the cobra effect on the containment strategy of covid-19. For this purpose, the study adopted an event study methodology to test the effect of the announcement of double lockdown on the spike rate of new covid-19 cases in Tamil Nadu, India. The findings of the longitudinal data analysis revealed a significant increase in covid-19 cases after the government announced a double lockdown. A deeper analysis to determine the factors influencing the abnormal rise in covid -19 cases (CAR) using regression analysis revealed a significant positive effect on population density and a negative impact on ICCC and HDI. Until now, no empirical research has evaluated the counter-effects of governments' protocol in containing a pandemic disease, by adopting an event study approach. Also, this study is the first in the literature to test the theoretical predictions of the cobra effect of the adopted protocol., Competing Interests: No potential competing interest was reported by the authors., (© 2021 Elsevier Ltd. All rights reserved.)

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is performed to diagnose and manage conditions of the biliary and pancreatic ducts. Though effective, it is associated with common adverse events (AEs). The purpose of this study is to systematically review ERCP AE rates and report up-to-date pooled estimates., Methods and Analysis: A comprehensive electronic search will be conducted of relevant medical databases through 10 November 2020. A study team of eight data abstracters will independently determine study eligibility, assess quality and abstract data in parallel, with any two concordant entries constituting agreement and with discrepancies resolved by consensus. The primary outcome will be the pooled incidence of post-ERCP pancreatitis, with secondary outcomes including post-ERCP bleeding, cholangitis, perforation, cholecystitis, death and unplanned healthcare encounters. Secondary outcomes will also include rates of specific and overall AEs within clinically relevant subgroups determined a priori. DerSimonian and Laird random effects models will be used to perform meta-analyses of these outcomes. Sources of heterogeneity will be explored via meta-regression. Subgroup analyses based on median dates of data collection across studies will be performed to determine whether AE rates have changed over time., Ethics and Dissemination: Ethics approval is not required for this study as it is a planned meta-analysis of previously published data. Participant consent is similarly not required. Dissemination is planned via presentation at relevant conferences in addition to publication in peer-reviewed journals. PROSPERO registration number CRD42020220221., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Context: Follicular keratotic disorder is an abnormal keratinization affecting the follicular orifices and clinically characterized by hyperkeratotic follicular papules affecting various sites. Dermoscopy is a non-invasive diagnostic tool and differentiates closely resembling diseases as well as possibly prevents need for an invasive biopsy., Aim: This study was aimed to find the correlation between clinical, dermoscopic and histopathological findings in follicular keratotic diseases and to establish the dermoscopic criteria in the diagnosis of primary follicular keratotic diseases., Materials and Methods: This was a hospital-based prospective cross-sectional study of 30 consecutive patients clinically diagnosed with follicular keratotic diseases, irrespective of age and duration of the disease., Results: The study consisted of 30 patients with a mean age of 19.57 ± 9.69 years. The most common primary follicular keratotic disease observed was phrynoderma and secondary follicular keratotic disease was follicular lichen planus (lichen planopilaris). The predominant dermoscopic finding among all the follicular keratotic diseases was perifollicular scaling 29 (96.7%) followed by keratotic plug 28 (93.3%). The most common histopathological feature was dilated follicular infundibulum 22 (73.3%) followed by follicular plug 15 (50%) and dermal perivascular infiltration 22 (73.3%). The clinical and dermoscopic features showed a significant statistical association with the histopathological findings., Conclusion: Dermoscopy is a simple, non-invasive diagnostic tool that helps in differentiating and diagnosing the closely resembling follicular keratotic diseases., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Indian Dermatology Online Journal.)

Background: Cellular diversity of the lung endothelium has not been systematically characterized in humans. We provide a reference atlas of human lung endothelial cells (ECs) to facilitate a better understanding of the phenotypic diversity and composition of cells comprising the lung endothelium., Methods: We reprocessed human control single-cell RNA sequencing (scRNAseq) data from 6 datasets. EC populations were characterized through iterative clustering with subsequent differential expression analysis. Marker genes were validated by fluorescent microscopy and in situ hybridization. scRNAseq of primary lung ECs cultured in vitro was performed. The signaling network between different lung cell types was studied. For cross-species analysis or disease relevance, we applied the same methods to scRNAseq data obtained from mouse lungs or from human lungs with pulmonary hypertension., Results: Six lung scRNAseq datasets were reanalyzed and annotated to identify >15 000 vascular EC cells from 73 individuals. Differential expression analysis of EC revealed signatures corresponding to endothelial lineage, including panendothelial, panvascular, and subpopulation-specific marker gene sets. Beyond the broad cellular categories of lymphatic, capillary, arterial, and venous ECs, we found previously indistinguishable subpopulations; among venous EC, we identified 2 previously indistinguishable populations: pulmonary-venous ECs (COL15A1 neg ) localized to the lung parenchyma and systemic-venous ECs (COL15A1 pos ) localized to the airways and the visceral pleura; among capillary ECs, we confirmed their subclassification into recently discovered aerocytes characterized by EDNRB , SOSTDC1 , and TBX2 and general capillary EC. We confirmed that all 6 endothelial cell types, including the systemic-venous ECs and aerocytes, are present in mice and identified endothelial marker genes conserved in humans and mice. Ligand-receptor connectome analysis revealed important homeostatic crosstalk of EC with other lung resident cell types. scRNAseq of commercially available primary lung ECs demonstrated a loss of their native lung phenotype in culture. scRNAseq revealed that endothelial diversity is maintained in pulmonary hypertension. Our article is accompanied by an online data mining tool (www.LungEndothelialCellAtlas.com)., Conclusions: Our integrated analysis provides a comprehensive and well-crafted reference atlas of ECs in the normal lung and confirms and describes in detail previously unrecognized endothelial populations across a large number of humans and mice.

Background and Aims: Clinical photography is a vital component of patient care in dermatology. Casual sharing of images over social media is a common practice among the clinicians. We performed this study to assess the perception and behavior of dermatologists toward clinical photography., Materials and Methods: A questionnaire having 10 questions was prepared using an online survey platform and the link to it was shared in a dermatologists group using the WhatsApp application. Among questions, nine were multiple choice type while the tenth was open ended. Some of the questions allowed multiple responses and answering all the questions was not mandatory. Resultant data was analyzed using Chi-square test for categorical variables and unpaired t -test to compare quantitative variables., Results: A total of 119 dermatologists participated in the study. Most respondents used personal smartphone (72.9%, 86/118) for imaging followed by digital camera (27.9%, 33/118). Monitoring the disease process (83.9%, 99/118) and research publications (51.6%, 61/118) were the commonest reasons for photography. Except one all participants had shared images and most commonly in professional WhatsApp groups (86.3%, 101/117) and to personal WhatsApp number (31.6%, 37/117). Patient consent for photography was duly recorded by very few (14.4%, 17/118). More than half (52.3%, 56/107) responded monitoring of the disease as the single most important application of clinical photography in dermatology., Conclusion: Adequate awareness regarding appropriate usage and safekeeping of gadget meant for imaging and necessity of obtaining written consent for taking as well as sharing the images and secure storage of the images was found to be lacking., Competing Interests: There are no conflicts of interest. Authors do not have any conflicts of interest to disclose, (Copyright: © 2021 Indian Dermatology Online Journal.)