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Ocimum tenuiflorum, commonly known as Tulsi, is revered in Ayurveda for its extensive medicinal properties. However, there is a need to consolidate current knowledge on its phytochemical constituents and their pharmacological activities to identify potential areas for further research and drug development. This review aims to bridge this gap by providing a comprehensive analysis of the bioactive secondary metabolites found in O. tenuiflorum, such as rosmarinic acid, oleanolic acid, luteolin, ursolic acid, and limonene, and their associated therapeutic effects. The review will highlight the pharmacological importance of these metabolites, which exhibit antioxidant, neuroprotective, anticancer, and anti‐inflammatory properties. Additionally, this study will explore the plant's wide range of beneficial qualities, including anti‐inflammatory, antioxidant, anticholinergic, pain‐relieving, antimicrobial, stress‐reducing, antidiabetic, anticancer, liver‐protective, ulcer‐inhibiting, antifungal, and wound‐healing attributes. Furthermore, this review focuses on the plant's potential in treating conditions such as asthma, persistent fever, tuberculosis, malaria, skin discoloration, itching, digestive issues, hemorrhoids, bone fractures, gout, urinary tract infection, and diabetes. By reviewing the current literature, the aim is to identify the gaps in the existing research and propose directions for future studies. This comprehensive review will serve as a valuable resource for researchers in the development and investigation of novel drugs derived from O. tenuiflorum. [ABSTRACT FROM AUTHOR]

The influence of UV radiation on skin discoloration, skin aging and the development of skin cancer is widely known. As a part of this study, the effect of extracts from three varieties of Cornus mas L. (C. mas L.) on skin cells exposed to UVA radiation was assessed. The analyses were performed on both normal and cancer skin cells. For this purpose, the potential photoprotective effects of the obtained extracts (aqueous and ethanolic) was assessed by performing two cytotoxicity tests (Alamar blue and Neutral red). Additionally, the antioxidant capacity was compared using three different assays. The 2′,7′-dichlorodihydrofluorescein diacetate (H2DCFDA) probe was used to evaluate the intracellular level of free radicals in cells exposed to the simultaneous action of UVA radiation and dogwood extracts. Additionally, the ability to inhibit excessive pigmentation was determined by assessing the inhibition of melanin formation and tyrosinase activity. The obtained results confirmed the strong antioxidant properties of dogwood extracts and their photoprotective effect on normal skin cells. The ability to inhibit the viability of melanoma cells was also observed. Additionally, a reduction in oxidative stress in skin cells exposed to UVA radiation and a strong inhibition of melanin formation and tyrosinase activity have been demonstrated. This study shows that dogwood extract could be a valuable cosmetic raw material that can play both a photoprotective and antihyperpigmentation role in cosmetic preparations. [ABSTRACT FROM AUTHOR]

The oculocutaneous albinism II (OCA2) gene encodes a melanosomal transmembrane protein involved in melanogenesis. Recent genome-wide association studies have identified several single nucleotide polymorphisms within OCA2 genes that are involved in skin pigmentation. Nevertheless, there have been no attempts to modulate this gene to improve skin discoloration. Accordingly, our aim was to identify compounds that can reduce OCA2 expression and to develop a formula that can improve skin brightness and reduce hyperpigmented spots. In this study, we investigated the effects of OCA2 expression reduction on melanin levels, melanosome pH, and autophagy induction through siRNA knockdown. Additionally, we identified several bioactives that effectively reduce OCA2 expression. Ultimately, in a clinical trial, we demonstrated that topical application of those compounds significantly improved skin tone and dark spots compared to vitamin C, a typical brightening agent. These findings demonstrate that OCA2 is a promising target for the development of efficacious cosmetics and therapeutics designed to treat hyperpigmentation. [ABSTRACT FROM AUTHOR]

Objective: Pharmacological activation of neuronal Kv7 channels by the antiepileptic drug retigabine (RTG; ezogabine) has been proven effective in treating partial epilepsy. However, RTG was withdrawn from the market due to the toxicity caused by its phenazinium dimer metabolites, leading to peripheral skin discoloration and retinal abnormalities. To address the undesirable metabolic properties of RTG and prevent the formation of phenazinium dimers, we made chemical modifications to RTG, resulting in a new RTG derivative, 1025c, N,N′‐{4‐[(4‐fluorobenzyl) (prop‐2‐yn‐1‐yl)amino]‐1,2‐phenylene}bis(3,3‐dimethylbutanamide). Methods: Whole‐cell recordings were used to evaluate Kv7 channel openers. Site‐directed mutagenesis and molecular docking were adopted to investigate the molecular mechanism underlying 1025c and Kv7.2 interactions. Mouse seizure models of maximal electroshock (MES), subcutaneous pentylenetetrazol (scPTZ), and PTZ‐induced kindling were utilized to test compound antiepileptic activity. Results: The novel compound 1025c selectively activates whole‐cell Kv7.2/7.3 currents in a concentration‐dependent manner, with half‐maximal effective concentration of.91 ±.17 μmol·L−1. The 1025c compound also causes a leftward shift in Kv7.2/7.3 current activation toward a more hyperpolarized membrane potential, with a shift of the half voltage of maximal activation (ΔV1/2) of −18.6 ± 3.0 mV. Intraperitoneal administration of 1025c demonstrates dose‐dependent antiseizure activities in assays of MES, scPTZ, and PTZ‐induced kindling models. Moreover, through site‐directed mutagenesis combined with molecular docking, a key residue Trp236 has been identified as critical for 1025c‐mediated activation of Kv7.2 channels. Photostability experiments further reveal that 1025c is more photostable than RTG and is unable to dimerize. Significance: Our findings demonstrate that 1025c exhibits potent and selective activation of neuronal Kv7 channels without being metabolized to phenazinium dimers, suggesting its developmental potential as an antiseizure agent for therapy. [ABSTRACT FROM AUTHOR]

Purpose: This retrospective study aimed to compare the efficacy and safety of transpedal access (TPA) with transfemoral access (TFA) in Genicular Artery Embolization (GAE). Materials and Methods: 60 patients who underwent GAE between January and June 2023, were recruited and outcomes were compared between the TFA (n = 37) and TPA (n = 23) groups. Technical and clinical success rates, complications, and patient-reported outcomes were assessed. Results: All patients attained a 100% technical success rate, which was defined as the successful selective catheterization and embolization of at least one feeding artery to the knee joint, without encountering any major complications. Minor complications, observed in 12/60 patients (20%), were predominantly manifested as a transient skin discoloration. The TPA group had a comparatively higher (p = 0.008) rate of minor complication than the TFA group. Notably, TPA was associated with a longer duration of the procedure (p = 0.013), duration of fluoroscopy (p = 0.004), increased total air kerma (p = 0.037), dose-area product values (p = 0.021), and a greater incidence of vasospasm (p = 0.018) than TFA. However, TPA patients reported shorter recovery times and less post-procedural discomfort, especially reduced back pain due to postinterventional bedrest (p < 0.001). At the 3-month follow-up, the clinical success rate was similar between the two groups (p = 0.905). Conclusion: TFA is the safer and faster method for GAE, offering fewer complications and reduced radiation exposure. For patients with challenging groin anatomies, however, TPA may provide a valuable alternative. [ABSTRACT FROM AUTHOR]

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Background: Skin conditions are common in patients on maintenance hemodialysis and those with pancreatitis. However, there is a lack of research on dermatological issues in patients who have both hemodialysis and pancreatitis concurrently. Case presentation: A 62-year-old male patient with a 4-year history of maintenance hemodialysis (MHD) presented with pain and was diagnosed with acute pancreatitis and gallbladder stones. Markedly elevated blood amylase, creatine kinase, and myoglobin were noted, alongside a purplish-red skin discoloration. Treatment included inhibition of digestive fluid secretion, anti-infection measures, blood purification, fasting, rehydration, and symptomatic care. Notably, continuous renal replacement therapy (CRRT) combined with hemoperfusion (HP) was employed. The patient's dialysis effluent initially appeared red. Upon examination of the patient's peripheral blood smear, red blood cell debris was not observed. The dialysis effluent (on Day 0) was analyzed, revealing no hemoglobin (0 g/L) but an elevated myoglobin concentration of 80.4 U/L. After the therapeutic intervention, the indicators, including the blood amylase, C-reactive protein, total bilirubin, creatine kinase, and myoglobin were improved. The patient experienced resolution of sternal and upper abdominal pain within two days. After four consecutive days of CRRT and HP treatment, the skin color returned to normal, alongside improved clarity of the dialysis effluent. Subsequently, the patient's method of blood purification was reverted to conventional hemodialysis. On the eighth day of hospitalization, the patient resumed normal diet and was discharged. Conclusions: In the case of the current patient with acute pancreatitis undergoing MHD, it is noteworthy to report the observation of a unique purplish-red skin discoloration. This phenomenon may be attributable to inflammation resulting from acute pancreatitis, and the retention of myoglobin within the body. [ABSTRACT FROM AUTHOR]

In recent years, a wide variety of high-performance and versatile nanofiber membranes have been successfully created using different electrospinning methods. As vehicles for medication, they have been receiving more attention because of their exceptional antibacterial characteristics and ability to heal wounds, resulting in improved drug delivery and release. This quality makes them an appealing choice for treating various skin conditions like wounds, fungal infections, skin discoloration disorders, dermatitis, and skin cancer. This article offers comprehensive information on the electrospinning procedure, the categorization of nanofiber membranes, and their use in dermatology. Additionally, it delves into successful case studies, showcasing the utilization of nanofiber membranes in the field of skin diseases to promote their substantial advancement. [ABSTRACT FROM AUTHOR]

Aim: Non‐tuberculous mycobacteria (NTM) lymphadenitis typically resolves spontaneously, yet factors influencing the duration remain explored. We aimed to identify clinical parameters associated with shorter spontaneous resolution. Methods: This cohort study included children with NTM lymphadenitis from 1 January 2015 to 1 March 2021 at Copenhagen University Hospital. Time‐to‐event analysis assessed clinical parameters associated with the duration of NTM lymphadenitis. Results: Sixty children (57% boys) with a median age of 24 months (range 11–84) were included; 13 (22%) received primary surgery, 13 (22%) underwent surgery after a wait‐and‐see period and 34 (57%) received no intervention. In children without intervention, the median duration was 10 months (range 2–25). Faster resolution was associated with parental‐reported lymph node enlargement within 2 weeks (HR 2.3, 95% CI 1.0–5.0; p = 0.044), abscess on ultrasound examination (HR 3.3, 95% CI 1.5–7.3; p = 0.003) and skin discoloration and/or perforation within 3 months of onset (HR 4.3, 95% CI 1.3–14.4; p = 0.017 and HR 3.7, 95% CI 1.5–9.1; p = 0.005). Conclusion: Knowledge of predictors for shorter spontaneous resolution of NTM lymphadenitis, such as rapid initial lymph node enlargement, abscess on ultrasound examination, and skin discoloration and/or perforation within 3 months of disease onset, may guide clinical management decisions concerning surgery versus a conservative approach. [ABSTRACT FROM AUTHOR]

Introduction: Considering the increasing number of conservative surgeries (quadrantectomies) for primary breast carcinoma, especially in the early stages, often followed by adjuvant radiotherapy, the incidence of radiation-associated angiosarcoma (RAS) is expected to rise in the coming decades, and it will represent a clinical and therapeutic challenge, as limited data are available due to the rarity and heterogeneity of the disease. Though the prognosis of these patients is poor, a number of clinical and pathological factors can be evaluated to better understand the course of RAS. The aim of this systematic review is to explore the available clinical-pathological, therapeutic, and prognostic data regarding RAS to evaluate its occurrence, diagnosis, treatment, and outcomes. Method: RAS clinical data were identified by a systematic review conducted in five different databases (Medline, Web of Knowledge, Google Scholar, Scopus, and Cochrane). Only RAS works published in English, with access to the full manuscript text, and with clear results, were considered as eligible. Results: We considered 52 papers comprising 319 RAS cases. The patient age at diagnosis ranged from 37 to 93 years, with most cases occurring from 5 to 10 years after breast irradiation. The most common clinical presentation was an aggressive development of macules, papules, or erythematous-violaceous skin discoloration at the site of previous radiation treatment for primary breast carcinoma. Complete surgical excision appeared to be the first-line treatment of the disease, in some cases followed by adjuvant local and/or systemic therapies. Despite different treatments, local recurrence rates ranged from 40% to 90%, leading to negative outcomes and poor prognosis for patients. Conclusion: Although the literature is limited and the data are heterogeneous and contentious, our review aims to highlight the importance of early diagnosis, multimodal treatment, and long-term follow-up of RAS in order to limit and prevent the aggressiveness of this neoplasm. [ABSTRACT FROM AUTHOR]

Background: Dark eye circle (DEC) is one of the most common cosmetic problems. It has a great impact on the patients' quality of life. Carboxytherapy is a cosmetic technique using pure carbon dioxide for different uses in different areas of the body. The goal of this study is to evaluate the efficacy and tolerability of carboxytherapy in the cosmetic correction of DECs. Methods: This study was conducted on 27 patients requesting the correction of DEC. The treatment was performed using a carboxy device in medical grade. The gas injection was performed intradermal after local anesthesia, with a pressure of one tenth bar and a speed of 20 cc/min, 1 cc in each upper and lower eyelid. The treatment sessions were done every 2 weeks for four sessions. Results: The mean physicians' score of DECs before and after treatment was 8.7 ± 0.81 and 4.6 ± 1.1, respectively. The mean patients' score before and after treatment was 9.2 ± 0.5 versus 5.41 ± 1.37. The mean scores showed a significant reduction of skin discoloration without major side effects (p < 0.00001). Conclusion: Carboxytherapy seems to be an effective treatment option for dark circles around the eyes with a good safety profile and patient satisfaction. [ABSTRACT FROM AUTHOR]

Introduction: The aging of the skin, which is affected by both external and internal causes, can reflect the external age and the internal health status. While the aging characteristics differ across ethnic groups, the specific changes in skin aging within the Chinese population have been underexplored. Moreover, investigating the similarity of aging skin characteristics between parent-offspring pairs remains uncharted territory. This study aims to fill these gaps by examining the skin aging features of Chinese women and assessing the similarity in aging skin characteristics between mother-daughter pairs. Methods: A total of 40 mother-daughter pairs were recruited and analyzed. The perceived ages of the participants were evaluated, and their aging skin traits were systematically graded. Statistical methods were employed to discern the trends of the aging skin characteristics. By introducing a novel similarity parameter, we compared whether various skin aging characteristics have similar patterns between mothers and daughters. Results: Our findings indicate that age 50 represents a pivotal point in skin aging. Beyond this age, the increase in rhytides and laxity scores accelerated noticeably, whereas the escalation in dyschromia scores became less marked. By introducing similar parameters between mother-daughter pairs and the radar map, we discovered that the skin aging characteristics are remarkably consistent between mother-daughter pairs. Conclusion: Understanding the main aging skin characteristics of different age groups can allow caregivers to devise treatments for preventing skin aging in women of various ages. The mother's skin aging trend is also significant for the daughter's skin aging prevention. Plain Language Summary: Skin aging, a complex process influenced by both internal and external factors, exhibits distinct patterns across ethnic groups. Despite this, the specific aging characteristics within the Chinese population and the hereditary similarities between parents and offspring have not been thoroughly investigated. To address this gap, our study focused on the skin aging features of Chinese women and explored the resemblance in these features between mother-daughter pairs. Eighty-seven women from the same community, including 40 mother-daughter pairs, participated in our study. We assessed how old each participant appeared to be and methodically evaluated their skin aging signs by a modified scale. With the introduction of a new similarity parameter, we further examined the extent to which skin aging traits showed parallel trends between mothers and their daughters. Our findings pinpoint age 50 as a pivotal moment in the skin aging trajectory, where the increase in wrinkles and skin laxity becomes more pronounced, contrasting with a deceleration in skin discoloration. Remarkably, a consistent pattern of aging characteristics was observed between mother-daughter pairs, suggesting a potential genetic influence. This study not only sheds light on the specific skin aging patterns among Chinese women but also underscores the significance of genetic factors in shaping these patterns. The insights gained pave the way for developing targeted interventions for skin aging prevention and treatment, emphasizing the importance of considering familial aging trends. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Neutrophilic eccrine hidradenitis (NEH) is one of the cutaneous manifestations of chemotherapy side effects. However, it can arise from other non‐chemotherapy medications. The granulocyte‐colony‐stimulating factor is a medication reported to trigger NEH. [ABSTRACT FROM AUTHOR]

Background: Macrophage activation syndrome (MAS) associated with Primary Sjogren's syndrome is a rare entity. The following are our observations on a patient of Indian origin who presented with features of cholestatic jaundice and was diagnosed with MAS. We also discuss the challenges faced during its management. Case description: A 53-year-old woman presented with generalized weakness and yellowish discoloration of skin, sclera, and urine for 1 month. She was evaluated for various etiologies of acute hepatitis. During this, the autoimmune profile was suggestive of Primary Sjogren's syndrome. Despite starting appropriate treatment, her liver dysfunction worsened, and her fever persisted. Further workup revealed high ferritin, triglycerides, and lactate dehydrogenase (LDH). Secondary hemophagocytic lymphohistiocytosis (sHLH) was suspected, and biopsies from the liver and bone marrow were performed. Macrophages, lymphocytes, and histiocytes were present in the marrow. Hence, she was diagnosed with MAS associated with portosystemic shunts (PSS) with liver dysfunction. She was treated with steroids, etoposide, cyclosporine, and intravenous immunoglobulin (IVIg). Despite best efforts, there was no clinical improvement, and she was discharged against medical advice. Six weeks later, she succumbed to her illness at home. Conclusion: Macrophage activation syndrome is a rare entity. The mortality is very high, especially when initial ferritin levels are elevated and also if they do not respond to steroids. [ABSTRACT FROM AUTHOR]

La mucormycose est une infection fongique rare et grave, survenant majoritairement sur des terrains immunodéprimés, diabétiques, des polytraumatismes ou des brûlures. Les traitements de références actuels reposent sur des parages chirurgicaux carcinologiques itératifs, un traitement systémique par amphotéricine B liposomale et en deuxième ligne par du Posaconazole ou Isavuconazole. Le cas d'une patiente de 37 ans sans antécédents, ayant présenté une mucormycose disséminée, avec perte de substance cutanée estimée à 25 % et délabrement majeur de la paroi thoracique est rapporté. En plus du traitement de référence, des instillations locales d'amphotéricine B en utilisant le système VAC Veraflow® ont été réalisées. Nous pensons que les instillations locales d'amphotéricine B par VAC pourrait permettre d'améliorer le pronostic fonctionnel des patients présentant une atteinte cutanée. Mucormycosis is a rare and serious fungal infection, occurring mainly in immunocompromised, diabetic, polytrauma or burn patients. Current standard treatments include iterative carcinological surgical trimming, systemic treatment with liposomal amphotericin B and second-line Posaconazole or Isavuconazole. We report the case of a 37-year-old female patient with no previous medical history who developed a disseminated mucormycosis, with an estimated 25 % loss of skin substance and major decay of the chest wall. In addition to standard treatment, local instillations of amphotericin B using the VAC Veraflow® system were performed. We believe that local instillations of amphotericin B by VAC could improve the functional prognosis of patients with skin involvement. [ABSTRACT FROM AUTHOR]

Background: Tear trough filling is a popular facial rejuvenation procedure, and hyaluronic acid is typically used as the filler of choice. However, Tyndall's phenomenon, a common complication following hyaluronic acid injection, can occur, leading to skin discoloration of the lower eyelid. Aims: This single‐center, prospective, comparative clinical study aimed to evaluate the efficacy of collagen and hyaluronic acid injections in treating tear trough deformity. Methods: Sixty patients were enrolled between June 2022 and January 2023. Patients were randomly allocated into three groups: Group A received hyaluronic acid, Group B received hyaluronic acid combined with collagen, and Group C received collagen alone. Baseline characteristics, including age, sex, and tear trough deformity grade were considered before therapy. Changes in tear trough deformity scores, Global Aesthetic Improvement Scores, and the presence of the Tyndall effect were analyzed at 1 and 3 months postinjection to determine differences among the three groups. Results: Baseline profiles of the three groups were similar. In the first month postinjection, there was no difference in the Global Aesthetic Improvement Scores and tear trough deformity between the three groups. However, in the third‐month postinjection, there was a significant difference in scores between patients in Group C and those in Groups A or B. The Tyndall effect manifested in three patients in Group A, which was significantly different from that in Groups B and C. Conclusion: The combined use of hyaluronic acid with collagen in injectable fillers corrected tear trough deformities and reduced the occurrence of the Tyndall phenomenon, which can be problematic with hyaluronic acid alone. Additionally, this combination may help overcome the disadvantage of a shorter retention period when using collagen alone. [ABSTRACT FROM AUTHOR]

Neurofibromatosis 1 (NF1) is a multisymptomatic disorder with highly variable presentations, which include short stature, susceptibility to formation of the characteristic benign tumors known as neurofibromas, intense freckling and skin discoloration, and cognitive deficits, which characterize most children with the condition. Attention deficits and Autism Spectrum manifestations augment the compromised learning presented by most patients, leading to behavioral problems and school failure, while fragmented sleep contributes to chronic fatigue and poor quality of life. Neurofibromin (Nf1) is present ubiquitously during human development and postnatally in most neuronal, oligodendrocyte, and Schwann cells. Evidence largely from animal models including Drosophila suggests that the symptomatic variability may reflect distinct cell-type-specific functions of the protein, which emerge upon its loss, or mutations affecting the different functional domains of the protein. This review summarizes the contributions of Drosophila in modeling multiple NF1 manifestations, addressing hypotheses regarding the cell-type-specific functions of the protein and exploring the molecular pathways affected upon loss of the highly conserved fly homolog dNf1. Collectively, work in this model not only has efficiently and expediently modelled multiple aspects of the condition and increased understanding of its behavioral manifestations, but also has led to pharmaceutical strategies towards their amelioration. [ABSTRACT FROM AUTHOR]

Background: Most of the murder victims in Nigeria are concealed in shallow graves or clandestine paths or bushes. Knowledge of postmortem interval (PMI) of buried carcasses is useful in estimating time since death for buried homicide scenarios. The PMI of buried remains is different from that of remains on the soil surface. Aims and Objectives: The study aimed at investigating the PMI of buried remains in a tropical rainforest vegetation of Nigeria using matured domestic pigs as human analogs. Materials and Methods: Four animals were used for this study. Animals were sacrificed and buried in one-foot-depth graves. A flat wood was placed on top of the animals before it was covered with sand so that the visible changes can be monitored during the study period. The study was carried out during the rainy and dry seasons. Soil analysis was carried out to ensure that there was no chemical substance inhibiting decomposition. Results: Animals did not completely skeletonize within the study period (168 days). However, four stages of decomposition were identified within the study period - Fresh, bloat, active decay, and advanced decay stages. Conclusions: The PMI was influenced by fungi activities and rain infusion. On the last day of the study, the decomposition was at the advanced decay stage and only few bones of the head, neck, trunk, and limbs were visible with greyish discoloration of the skin and other visceral structures. The visible post-mortem changes of the buried carrions noted in this study may be used to estimate the time of death of buried humans in a tropical rainforest vegetation of Nigeria. [ABSTRACT FROM AUTHOR]

A subtype of cutaneous lupus erythematosus known as lupus erythematosus tumidus (LET) is characterized by sun-exposed areas that typically display urticaria-like papules and plaques. For LET, systemic therapy with antimalarials – particularly hydroxychloroquine (HCQ) – is the first line of treatment. Even though the safety profile of these medications appears to be high, there have been very few reports of side effects in the literature, including hemolytic anemia, retinal toxicity, maculopapular rash, gastrointestinal disturbance, and blue-gray discoloration of the skin or mucous membranes. Here, we report a unique instance of a 46- year-old LET smoker who, following HCQ treatment, developed a generalized myopathy. [ABSTRACT FROM AUTHOR]

Radiotherapy (RT) is an integral part of many cancer treatment protocols. Chronic radiation-induced dermatitis (CRD) is a cutaneous toxicity that occurs in one-third of all patients treated with this method. CRD is usually observed several months after completion of treatment. Typical symptoms of CRD are telangiectasia, skin discoloration, atrophy, thickening, and cutaneous fibrosis. There are currently no data in the literature on the evaluation of the dermoscopic features of CRD. The aim of this prospective study was the identification of clinical and dermoscopic features in a group of 32 patients with head and neck cancer (HNC) in whom CRD developed after RT. CRD was assessed at 3, 6, and 12 months after RT in 16, 10, and 10 patients, respectively. CRD was assessed at one time point and two time points in 28 and 4 patients, respectively. The control included skin areas of the same patient not exposed to RT. The dataset consisted of 36 clinical and 216 dermoscopic photos. Clinical evaluation was performed according to the RTOG/EORTC radiation-induced dermatitis scale. The highest score was grade 2 observed in 21 patients. Clinical observations revealed the presence of slight and patchy atrophy, pigmentation change, moderate telangiectasias, and some and total hair loss. Dotted vessels, clustered vessel distribution, white patchy scale, perifollicular white color, white structureless areas, brown dots and globules, and white lines were the most frequently noted features in dermoscopy. Three independent risk factors for chronic toxicity, such as age, gender, and surgery before RT, were identified. The dermoscopic features that had been shown in our study reflect the biological reaction of the skin towards radiation and may be used for the parametrization of CRD regarding its intensity and any other clinical consequences in the future. [ABSTRACT FROM AUTHOR]

Purpose: We aim to compare the different treatment modalities of non-tuberculous cervicofacial lymphadenitis in children, by means of a retrospective study conducted in the University Hospitals of Leuven of patients treated between 2012 and 2022. Methods: For this retrospective cohort study, data were collected and pseudonimised from 52 patients with non-tuberculous cervicofacial lymphadenitis, who were treated in our hospital between January 2012 and December 2022, either conservatively, antibiotically, surgically, or with a combination of these options. We only included patients who were considered immunocompetent. All of the included patients were below 10 years at time of treatment. We collected data regarding time to resolution and adverse effects, i.e., skin discoloration, excessive scar formation, fistula formation, persistence of adenopathies after treatment, need for additional treatment, facial nerve paresis/paralysis, or systemic side-effects due to antibiotic treatment. Results: The mean time to resolution (in days) when looking at primary treatments, was shortest in partial excisions (16), followed by complete excisions (19), antibiotic therapy (129), incision and drainage (153), curettage (240), and finally conservative management (280). Taking into account isolated treatments (i.e., both primary and adjuvant), we also observed consistently faster time to resolution in surgical and antibiotic treatments when compared to conservative treatment. Antibiotic therapy (p = 0.003), incision and drainage (p = 0,004) were associated with a significantly higher need for adjuvant treatment. Curettage was associated with a higher incidence of fistula formation (p = 0,006) and higher number of adjuvant treatments (p = 0,002). Conclusions: This study shows a faster resolution of nontuberculous mycobacterial cervicofacial lymphadenitis in children when treated surgically, more specifically when treated with partial or complete lymph node excision. Antibiotic treatment also leads to faster resolution than conservative management. There was a low rate of complications, and no permanent facial nerve damage was reported. [ABSTRACT FROM AUTHOR]

Key Clinical Message Neutrophilic eccrine hidradenitis (NEH) is one of the cutaneous manifestations of chemotherapy side effects. However, it can arise from other non‐chemotherapy medications. The granulocyte‐colony‐stimulating factor is a medication reported to trigger NEH.

For cosmetic purposes, there are many various cosmetic procedures. The most common and convenient procedure is face implants. Several face implant-related complications are reported. Ultrasonography is a useful and easy way to evaluate superficial complications of cosmetic procedures. This study aims to evaluate sonographic findings of cosmetic-related complications and correlate them with pathologic results. • Facial Balancing and Enhancing used to bring balance to the appearance of face. commonly used to enhance the chin, jaw and/or cheeks. • Botox, Cheek lift, Chemical peel, Chin surgery, Cosmetic dentistry Dermabrasion • Eyebrow/forehead rejuvenation (brow lift) Blepharoplasty (eyelid) • Allergies to tape, suture materials and glues, blood products, topical preparations or injected agents • Anesthesia risks • Bleeding • Change in skin sensation • Damage to deeper structures – such as nerves, blood vessels, muscles and lungs – can occur and may be temporary or permanent • Firmness around the implant • Infection • Persistent pain • Poor healing of incisions • Possible revisional surgery • Shifting of implants • Skin contour irregularities • Skin discoloration, swelling and sensitivity Unfavorable scarring • Foreign body granuloma • Lipogranulomatous inflammation • Sclerosing lipogranulomatous inflammation Foreign body granuloma including gelatin-like material • Parakeratosis • Dermatitis • Scleroderma • Dermatofibroma • Panniculitis, Fat necoris • Abscess • Cystic change • Granuloma • Injection droplets • Diffuse inflammatory mass/inflammation • Skin thickening and irregularity • Skin depression • Palpable mass in deep tissue • Remnant lesions [ABSTRACT FROM AUTHOR]

Evidence of fungal coexistence in humans points towards fungal adaptation to the host environment, like the skin. The human commensal Malassezia has evolved, especially residing in sebum-rich areas of the mammalian body where it can get the necessary nutrition for its survival. This fungus is primarily responsible for skin diseases like Pityriasis versicolor (PV), characterized by hypo or hyperpigmented skin discoloration and erythematous macules. In this manuscript, we report a 19-year-old healthy female who presented with a one-year history of reddish, hypopigmented, asymptomatic lesions over the chest and a raised erythematous lesion over the face. Upon clinical observation, the patient displayed multiple erythematous macules and erythematous papules over the bilateral malar area of the face, along with multiple hypopigmented scaly macules present on the chest and back. Based on the above clinical findings, a diagnosis of PV and Acne vulgaris (AV) was made. Interestingly, the patient was immunocompetent and didn't have any comorbidities. Upon isolation of skin scrapings and post-culturing, we found the existence of three fungal genera in the same region of the patient's body. We further went on to confirm the identity of the particular species and found it to represent Malassezia, Rhodotorula, and Candida. We report how Malassezia, the predominant microbial resident skin fungus, coexists with other fungal members of the skin mycobiome. This study on an applied aspect of microbiology also shows how important it is to identify the fungal organism associated with skin infections so that appropriate therapeutics can be advised to avoid cases of relapse. Key points: Identification of fungal species in skin infection is of utmost importance. In this report we show the existence of 3 fungal genera from the same infection site. Proper identification will help deliver appropriate therapeutics and prevent cases of relapse. [ABSTRACT FROM AUTHOR]

Carotenodermia is a yellow to orange skin discoloration due to epidermal deposition of carotene. This can be due to an abnormality in the conversion of β‐carotene to vitamin A, hyperlipidemia, or high dietary carotene intake. Here, I review approximately 100 previous cases of carotenodermia in humans due to high β‐carotene intake. This literature review revealed that in carotenodermia associated with high β‐carotene intake the discoloration tends to be widespread, mainly in thick areas of the skin (e.g., the palm of the hand), and can last from 14 days to 4.5 years. This review provides a detailed overview of the characteristics of diet‐induced carotenodermia. [ABSTRACT FROM AUTHOR]

Background: Arteriovenous malformation (AVM) of the breast is a rare condition that is usually incidentally detected as discoloration of the skin. Patients are asymptomatic, and it is mostly left undisturbed. However, the closest differential diagnosis of primary angiosarcoma of the breast can have a similar imaging appearance. Multimodality imaging will help to differentiate between the two, and in very few cases, tissue diagnosis warrants confirmation. Case presentation: We hereby report the case of a young female who initially presented with swelling and discoloration near her face and neck and who, on a oneyear follow-up, incidentally noticed discoloration over her left breast. She underwent an ultrasound, a dynamic contrast-enhanced MRI of both breasts and a dedicated left breast X-ray mammogram. Conclusion: With all these modalities confirmed, the discoloration was caused by an AVM of the breast. [ABSTRACT FROM AUTHOR]

Background: ATL1102 is a 2'MOE gapmer antisense oligonucleotide to the CD49d alpha subunit of VLA-4, inhibiting expression of CD49d on lymphocytes, reducing survival, activation and migration to sites of inflammation. Children with DMD have dystrophin deficient muscles susceptible to contraction induced injury, which triggers the immune system, exacerbating muscle damage. CD49d is a biomarker of disease severity in DMD, with increased numbers of high CD49d expressing T cells correlating with more severe and progressive weakess, despite corticosteroid treatment. Methods: This Phase 2 open label study assessed the safety, efficacy and pharmacokinetic profile of ATL1102 administered as 25 mg weekly by subcutaneous injection for 24 weeks in 9 non-ambulatory boys with DMD aged 10–18 years. The main objective was to assess safety and tolerability of ATL1102. Secondary objectives included the effect of ATL1102 on lymphocyte numbers in the blood, functional changes in upper limb function as assessed by Performance of Upper Limb test (PUL 2.0) and upper limb strength using MyoGrip and MyoPinch compared to baseline. Results: Eight out of nine participants were on a stable dose of corticosteroids. ATL1102 was generally safe and well tolerated. No serious adverse events were reported. There were no participant withdrawals from the study. The most commonly reported adverse events were injection site erythema and skin discoloration. There was no statistically significant change in lymphocyte count from baseline to week 8, 12 or 24 of dosing however, the CD3+CD49d+ T lymphocytes were statistically significantly higher at week 28 compared to week 24, four weeks past the last dose (mean change 0.40x109/L 95%CI 0.05, 0.74; p = 0.030). Functional muscle strength, as measured by the PUL2.0, EK2 and Myoset grip and pinch measures, and MRI fat fraction of the forearm muscles were stable throughout the trial period. Conclusion: ATL1102, a novel antisense drug being developed for the treatment of inflammation that exacerbates muscle fibre damage in DMD, appears to be safe and well tolerated in non-ambulant boys with DMD. The apparent stabilisation observed on multiple muscle disease progression parameters assessed over the study duration support the continued development of ATL1102 for the treatment of DMD. Trial registration: Clinical Trial Registration. Australian New Zealand Clinical Trials Registry Number: ACTRN12618000970246. [ABSTRACT FROM AUTHOR]

Background: Ampullary adenomas are premalignant lesions. However, biliary obstruction causing jaundice is rare. Duodenal intussusception secondary to an ampullary adenoma rarely occurs because of the fixed position of the duodenum in the retroperitoneum. Herein, we have described a rare case of ampullary adenoma with jaundice caused by duodenal intussusception. Case presentation: A 40-year-old woman presenting with vomiting and yellowish discoloration of the skin was admitted to another hospital. The patient had experienced recurrent epigastric pain and vomiting for the past 18 months. Blood test results showed elevated levels of bilirubin (3.9 mg/dL), and abdominal computed tomography (CT) showed a 60-mm hypovascular mass in the third part of the duodenum and a left lateral shift of the dilated common bile duct. The patient was referred to our hospital for further evaluation. She recovered from hyperbilirubinemia spontaneously (levels of bilirubin, 1.0 mg/dL), and the CT showed a tumor shift from the third part of the duodenum to the second part and improvement of the dilated common bile duct. Hypotonic duodenography revealed a tumor that moved easily from the second to the third portion of the patient's position. Upper gastrointestinal endoscopy revealed a large papillary tumor occupying the second part of the duodenum, which was diagnosed as an adenoma through biopsy. The possibility of malignancy could not be negated owing to the presence of jaundice and an elevated carbohydrate antigen 19-9 level (76.0 U/mL). Pancreaticoduodenectomy was performed. The resected specimen showed a 60 × 40 × 40-mm pedunculated ampullary mass with submucosal elongation. The pathological examination indicated that the ampullary tumor was a high-grade intestinal adenoma. The postoperative course was uneventful, and the patient was discharged 26 days postoperatively. Conclusions: This report describes a rare case of a patient with an ampullary adenoma presenting with jaundice resulting from duodenal intussusception. Owing to the possibility of a postoperative cancer diagnosis which may have caused the biliary obstruction and the difficulty in making an accurate preoperative diagnosis, it is imperative to choose the appropriate surgical procedure such as a pancreaticoduodenectomy. [ABSTRACT FROM AUTHOR]

Background: Melasma results from the imbalance of the mechanisms that regulate skin pigmentation, causing the appearance of hyperpigmented patches. Treatment includes topical and oral agents, chemical peelings, microneedling, and laser therapy. The picosecond laser was developed to minimize pain and skin discoloration, which can sometimes be associated with laser treatments. It emits short pulses of energy that last from 300 to 500 picoseconds, leading to a more significant fragmentation of melanin, with miniminal risk of scarring and thermal lesions in the surrounding skin. Objective: The authors aimed to review the use of picosecond laser in the treatment of melasma and further provide an overview of the other current available options. Conclusions: While the use of picosecond laser for the treatment of melasma has yielded good results, further studies with longer follow-up periods and a higher number of patients are needed. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to investigate bacterial disease outbreaks in Indian major carp from aquaculture systems in Tripura, India, and identify the bacterial species associated with those outbreaks. Methods: A 3‐year surveillance was conducted in eight districts of Tripura, during which nine bacterial disease outbreaks were recorded. Fourteen bacterial strains isolated from diseased Indian major carp were selected and identified using phenotypic, molecular (16S ribosomal RNA gene), and phylogenetic analyses. In vitro pathogenicity studies were performed to assess the potential pathogenicity of the isolated bacteria. Result: The selected isolated strains were preliminarily identified under the genera Aeromonas (9 isolates), Acinetobacter (1 isolate), Citrobacter (3 isolates), and Pseudomonas (1 isolate). Molecular and phylogenetic analyses confirmed the species of the isolated bacteria, including Aeromonas jandaei (strains COF_AHE09 and COF_AHE61), Aeromonas veronii (strains COF_AHE13, COF_AHE52, COF_AHE55, COF_AHE56, and COF_AHE62), Aeromonas hydrophila (strains COF_AHE51 and COF_AHE58), Acinetobacter pittii (strain COF_AHE14), Citrobacter freundii (strains COF_AHE20, COF_AHE57, and COF_AHE59), and Pseudomonas aeruginosa (strain COF_AHE54). Behavioral and clinical signs observed in the diseased fish, such as lethargy, skin hemorrhaging, ulcers, fin and tail rot, exophthalmia, distended abdomen, scale loss, and skin discoloration, indicated the presence of bacterial septicemia. The in vitro pathogenicity studies highlighted the potential role of these bacteria in disease development, especially under environmental stress. Conclusion: This study provides valuable insights into the diversity of bacterial species associated with bacterial disease outbreaks in Indian major carp from aquaculture systems in Tripura. It serves as the first comprehensive investigation of its kind, contributing to our understanding of bacterial infections in Indian major carp. Impact statementThis study unveiled harmful bacteria causing disease outbreaks in Indian major carp, affecting both people and the environment. Identifying these strains informs us of their threat to aquatic life, emphasizing the need for improved disease control in aquaculture. [ABSTRACT FROM AUTHOR]

Background: Although India has achieved national level elimination of leprosy in December 2005, it reports highest number of leprosy cases in the world. Incidence of leprosy amongst young children indicates active foci of transmission in the community, making it a robust epidemiological indicator to assess the progress of leprosy control programs. Aim and Objectives: To study prevalence, clinical spectrum, patterns of extracutaneous involvement, reactions, relapse, demographic profile, anthropometric characteristics of children with leprosy. Materials and Methods: A prospective observational study of children younger than 14 years old with clinical signs and symptoms of leprosy, including cases diagnosed from October 2018 through September 2020 at a tertiary hospital in Eastern India. Results: Childhood leprosy constituted of 10.4% of total new leprosy cases. Mean age observed was 11.14 ± 1.5 years. 30.4% were females and 69.6% were males. The mean average duration was 9.95 ± 12.3 months. 82.1% of children belong to below poverty line (BPL) status. 19.6% of children had malnourishment/stunting/thinness, and 55.4% had anemia. 84.1% presented with skin discoloration. The most common site affected was upper limb (57.1%). 29.2% had contact history. A single case of relapse (1.7%) was reported. Most common peripheral nerve involved was ulnar nerve (67.8%). 8.9% of children had type 1 lepra reaction, and 1.7% had type 2 lepra reaction. 73.21% presented with borderline tuberculoid clinical type of leprosy. 19.6% showed slit skin smear positivity. Conclusion: Pockets of high endemicity of childhood leprosy as detected in the current study point toward the unmet need of better healthcare facilities along with increased awareness, campaigns, and school surveys for early diagnosis and treatment for the prevention of complications and spread in community. [ABSTRACT FROM AUTHOR]

Patients with extensive and complex wounds due to Necrotizing Soft-Tissue Infections (NSTI) may be referred to a burn center. This study describes the characteristics, outcomes, as well as diagnostic challenges of these patients. Patients admitted to three hospitals with a burn center for the treatment of NSTI in a 5-year period were included. Eighty patients (median age 54 years, 60% male) were identified, of whom 30 (38%) were referred by other centers, usually after survival of the initial septic phase. Those referred from other centers, compared to those primarily admitted to the study hospitals, were more likely to have group A streptococcal involvement (62% vs 35%, p =.02), larger wounds (median 7% vs 2% total body surface area, p <.001), and a longer length of stay (median 49 vs 22 days, p <.001). Despite a high incidence of septic shock (50%), the mortality rate was low (12%) for those primarily admitted. Approximately half (53%) of the patients were initially misdiagnosed upon presentation, which was associated with delay to first surgery (16 hours vs 4 hours, p <.001). Those initially misdiagnosed had more (severe) comorbidities, and less frequently reported pain or blue livid discoloration of the skin. This study underlines the burn centers' function as referral centers for extensively affected patients with NSTI. Besides the unique wound and reconstructive expertise, the low mortality rate indicates these centers provide adequate acute care as well. A major remaining challenge remains recognition of the disease upon presentation. Future studies in which factors associated with misdiagnosis are explored are needed. [ABSTRACT FROM AUTHOR]

Endogenous ochronosis, also known as alkaptonuria, is a rare disease known for its bluish-black discoloration of the skin, sclerae, and pinnae, as well as urine that turns black upon standing. Though rarely fatal, joint degradation is a common sequela, and many patients require multiple large joint arthroplasties throughout their lifetime. Though many aspects of the pathophysiological mechanisms of the disease have been described, questions remain, such as how the initiation of ochronotic pigmentation is prompted and the specific circumstances that make some tissues more resistant to pigmentation-related damage than others. In this report, we present the case of an 83-year-old female previously diagnosed with alkaptonuria including high-quality arthroscopic images displaying the fraying of articular cartilage. We also offer a summary of the latest literature on the pathophysiological mechanisms of the disease, including cellular-level changes observed in ochronotic chondrocytes, biochemical and mechanical alterations to the cartilaginous extracellular matrix, and patterns of pigmentation and joint degradation observed in humans and mice models. With these, we present an overview of the mechanisms of ochronotic chondropathy and joint degradation as the processes are currently understood. While alkaptonuria itself is rare, it has been termed a "fundamental disease," implying that its study and greater understanding have the potential to lead to insights in skeletal biology in general, as well as more common pathologies such as osteoarthritis and their potential treatment mechanisms. [ABSTRACT FROM AUTHOR]

A pseudocyst of pinna is benign, painless, rare and asymptomatic swelling on the lateral or anterior surface of the pinna resulting from intracartilaginous accumulation of fluid. The condition auricular pseudocyst was first described by Engel (Arch Otolaryngol 83:197–202, 1966). Pseudocyst of in majority of cases presents as unilateral lesions, predominantly in 35–40 years mean age group and affecting predominantly males (Ramadass and Ayyaswamy in Indian J Otolaryngol Head Neck Surg 58:156–192, 2006). Commonly these cysts shows no symptoms but occasionally, there may be presence of minor discomfort and mild inflammatory signs. The pseudocyst of pinna typically involves in its descending order of involvement as scaphoid fossa, triangular fossa of the antihelix, and the Cymba concha (Ramadass and Ayyaswamy in Indian J Otolaryngol Head Neck Surg 58:156–192, 2006). Diagnosis of psuedocyst is based mainly on the clinical characteristics without evidence of infection (Ramadass and Ayyaswamy in Indian J Otolaryngol Head Neck Surg 58:156–192, 2006). There are wide range of treatment modalities described in the literature for this condition ranging from medical line of management including minimally invasive Intralesional steroid therapy, intralesional sclerosant therapy, systemic steroid therapy to surgical line of management including aspiration and pressure dressing, quilting suture with corrugated rubber drain, incision and drainage with mastoid dressing, cartilage curettage with drainage tube, surgical de-roofing and cartilage window procedure. Although multiple treatment options are available for this condition,there is no gold standard option is found In literature as more invasiveness of procedure associated with more complications and less invasiveness is associated with more recurrence (Bhat et al. in J Clin Diagn Res 8:KC05–KC07, 2014). The main aim of treatment is preservation or restoration of normal Anatomy or architecture of the auricle without recurrence or complications in postoperative duration (Schulte et al. in J Am Acad Dermatol 44:285–286, 2001). In our study we are going to compare the surgical deroofing with buttoning technique with Posterior Cartilage window with Pressure Gauze dressing technique in patients with pseudocyst on the basis of recurrence and complications. To compare effectiveness in terms of recurrence and complications between surgical deroofing with buttoning technique and posterior cartilage window with Pressure Gauze dressing technique in patients with pseudocyst of pinna. Prospective observational study done for duration of one year from June 2021 till June 2022 at Ashwini Rural medical college and Hospital, Solapur. Study was done on 30 patients aged between 20 and 70 years with pseudocyst of who are diagnosed on the basis of clinical presentation and characteristics of the aspirated fluids with no signs of infection or inflammation. Among 30 patients with pseudocyst 15 patients were undergone surgical deroofing with buttoning technique and remaining 15 patients were undergone posterior cartilage window with Pressure Gauze dressing technique. The age distribution of patients with psuedocyst of pinna in our study ranged from 20 to 70 years with maximum number of cases (i.e. 16) in the age group of 30–40 years which comprised of about 53% of study population. Among 30 cases in our study 26 were males (86.7%). All cases were of unilateral pseudocyst with left ear involvement more than right ear i.e. 20 and 10 cases respectively which indicates predominantly affecting left ear (66.6%). In our study we observed the site of involvement of pinna by pseudocyst showing maximum number of cases involving combined scaphoid fossa and triangular fossa i.e. 15 cases (50%) and minimum number of cases involving Concha i.e. 2 cases (6.6%). In our study we found that the aspirated fluid from pseudocyst of pinna was sterile in all cases i.e. 30 cases (100%). In our study we observed that the aspirated fluid was serous in majority of cases i.e. 21 cases (70%) and serosanguinous in few of them i.e. 3 cases (10%). Success rate in our study for surgical deroofing with buttoning technique was 66.6% and for posterior cartilage window with Pressure Gauze dressing technique was 100% but in terms recurrence of pseudocyst of pinna, 2 groups were not statistically significant. Success rate in our study for posterior cartilage window with Pressure Gauze dressing technique was 100% with no recurrence. Among patients who have undergone surgical deroofing with buttoning technique 2 cases have minor complications like pressure discoloration of skin i.e. 1 case and thickening of skin of pinna i.e. 1 case. All these complications are temporary one and show recovery in follow up duration. Among patients who have undergone Posterior cartilage window with Pressure Gauze dressing technique 1 case had perichondritis at 1 week follow up which was resolved spontaneously at the end of 2 weeks and 2 cases had painless thicknening of pinna which also resolved spontaneously at the end of 2 weeks. Pseudocyst of pinna occurs commonly in middle aged males as unilateral lesions with left ear involvement in majority of cases. The most common involvement of pinna by pseudocyst is combined scaphoid fossa and triangular fossa, the least common site is concha. Most of the pseudocyst of pinna contain sterile serous fluid. Success rate in our study for surgical deroofing with buttoning technique was 66.6% and for posterior cartilage window with Pressure Gauze dressing technique was 100% but in terms recurrence 2 groups were not statistically significant. Both surgical treatment groups have few and temporary complications but in terms of complications 2 groups were not statistically significant. [ABSTRACT FROM AUTHOR]

Introduction: Peripheral vascular disease (PVD), peripheral arterial disease (PAD) and peripheral venous disease (PVD) are associated with a high risk of cardiovascular mortality, stroke, myocardial infarction, development of infections and loss of limb. Diagnosis in the emergency department (ED) is often challenging because of the most common symptoms which are pain, weakness, numbness, and/or swelling of an extremity as complaints may be masked by other causes-lumbar degenerative disease, osteoarthritis, diabetic neuropathy, etc. Objective: To assess the prevalence of peripheral vascular disease in emergency department patients and to develop a diagnostic algorithm to differentiate emergency conditions among them and their timely referral for hospitalization. Material and methods: Forty-two patients aged 27 to 88 years screened in the ED in 2023 and coded in the Hospital Information System (HIS) with ICD diagnoses I70; I80 and complications of PAD coded with ICD diagnoses I71.4; I72.4; I74 were prospectively followed. Results: Of the patients with vascular disease, 71% (n=30) were male and 29% (n=12) were female. Of them, 43% (n=18) had PAD, and 57% (n=24) had PVD of the lower extremities. The most common clinical symptoms referring patients to ED are: chronic debilitating pain in the limb, nocturnal pain, fatigue on movement, numbness and tingling, frequent muscle cramps, sensation of "coldness" in the limb, skin discoloration, swelling and edema, enlargement of visible veins, appearance of a non-healing wound with an unpleasant odor. The most common risk factors are: smoking, diabetes, obesity, arterial hypertension. Complications leading to hospitalization were observed in 72% of patients with PAD and in 8% of those with PVD; 28% of patients with PAD and 92% of those with PVD were referred for outpatient home treatment and follow-up by an angiologist or vascular surgeon. The diagnostic algorithm is developed (Fig. 1). Conclusion: 72% of patients with PAD and 8% of those with PVD had indications for emergency hospitalization at their ED visit. Timely diagnosis of peripheral vascular disease in the CO, saves a limb, improves the quality of life of patients. Many peripheral vascular diseases are detected in the course of another disease for which patients have visited the SO. Successful treatment of peripheral vascular disease requires correct, timely, and effective identification of patients who do have the disease and referral to an angiologist. [ABSTRACT FROM AUTHOR]

Adverse events of OTC products are not uncommon. We observed a peculiar adverse effect in three adolescent females using an acne lotion, who developed a yellowish discoloration of their hands, but not on the facial sites of application. Inspection under Wood's light helps to identify affected areas. We suppose a possible involvement of methenamine. We wish to draw attention to underreported unwanted side effects of topical preparations. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to quantitatively assess the effectiveness of microneedle mesotherapy in reducing skin discoloration. The results were analyzed using the gray-level co-occurrence matrix (GLCM) method. Material and methods: The skin of the forearm (7 × 7 cm) of 12 women aged 29 to 68 was examined. Microneedle mesotherapy was performed using a dermapen with a preparation containing 12% ascorbic acid. Each of the volunteers underwent a series of four microneedle mesotherapy treatments. The effectiveness of the treatment was quantified using the methods of image analysis and processing. A series of clinical images were taken in cross-polarized light before and after a series of cosmetic procedures. Then, the treated areas were analyzed by determining the parameters of the gray-level co-occurrence matrix (GLCM) algorithm: contrast and homogeneity. Results: During image pre-processing, the volunteers' clinical images were separated into red (R), green (G) and blue (B) channels. The photos taken after the procedure show an increase in skin brightness compared to the photos taken before the procedure. The average increase in skin brightness after the treatment was 10.6%, the average decrease in GLCM contrast was 10.7%, and the average homogeneity increased by 14.5%. Based on the analysis, the greatest differences in the GLCM contrast were observed during tests performed in the B channel of the RGB scale. With a decrease in GLCM contrast, an increase in postoperative homogeneity of 0.1 was noted, which is 14.5%. [ABSTRACT FROM AUTHOR]

Introduction: Wound management is a challenge in terms of the way, duration and cost of treatment both for the patient and health providers. The healing of skin wounds is a highly multi-step coordinated process. Objective monitoring of treatment at every stage is necessary to assess the applied therapy. Aim: To show the possibility of using the AutoCad software (ACS) as a tool with a slight measurement error for accurate measurement of the venous leg ulcers on the lower limbs. Material and methods: To determine the error of the measurement method Circle Templates For Drafting for four different sizes were used as ulcer models. Seventy-six wounds of various sizes from patients with venous leg ulcers (VLUs) were photographed and outlined with a marker on a transparent foil. The wounds were measured both using ACS and digital planimetry with C-Geo software (CGS). Data were analysed using Wilcoxon test, intraclass correlation coefficient (ICC) and Bland-Altman analysis. Results: The mean relative error of the surface wound model area measured by the ACS was 0.30 ±0.31% (range: 0.004-1.25) and a median of 0.18%. Areas and perimeters measured with ACS were higher than areas and perimeters measured with CGS, and the difference was statistically significant. Conclusions: The analysis of the wound images obtained in the ACS showed a very high potential of the software in terms of the accuracy of the analysed areas, which significantly increases the possibility of the analysis and reduces the measurement error in relation to planimetry using a digital digitizer. [ABSTRACT FROM AUTHOR]

Purpose: Postoperative sympathetic chain dysfunction (PSCD) was a relatively common complication after anterior lumbar interbody fusion due to the manipulation adjacent to the lumbar sympathetic chain (LSC). This study aimed to investigate the incidence of PSCD and identify its related independent risk factors after oblique lateral lumbar interbody fusion (OLIF) surgery. Methods: PSCD was defined as either of the following in the affected lower limb compared to the contralateral: (1) increase in skin temperature by 1 ºC or more, (2) reduced skin perspiration, (3) limb swelling or skin discoloration. Consecutive patients who underwent OLIF at L4/5 level from February 2018 and May 2022 at a single institution were retrospectively reviewed and divided into two groups: patients with PSCD and patients without PSCD. Binary logistic regression analyses were performed on patients' demographic, comorbidities, radiological datum and perioperative factors to identify independent risk factors for PSCD. Results: Twelve (5.7%) of 210 patients experienced PSCD following OLIF surgery. Multivariate logistic regression analysis identified the identification of lumbar dextroscoliosis (OR = 7.907, P = 0.012) and the presence of "tear-drop" psoas (OR = 7.216, P = 0.011) as independent risk factors for the PSCD following OLIF. Conclusion: This study identified the lumbar dextroscoliosis and the "tear-drop" psoas as independent risk factors for the development of PSCD after OLIF. Spine alignment examination and the morphological identification of psoas major muscle should be highly noticed for the PSCD prevention following OLIF. [ABSTRACT FROM AUTHOR]

Background: Group A streptococcus is a common cause of pharyngitis and can also cause a wide variety of invasive infections, including necrotizing soft-tissue infections. The presented case is one of the rare occurrences of necrotizing soft-tissue infection as a consequence of hematogenous spread and is the first described pediatric case of streptococcal myositis that was clearly preceded by pharyngitis. Case Report: A 2.5-year-old boy, previously healthy, fell ill 3 days before admission with high-grade fever, diffuse erythematous truncal rash and, later, with pain in the left lower leg. The next day, scarlet fever was diagnosed, and he was started on oral penicillin V. In the following 2 days, the fever and pain in the leg did not subside; edema and redness of the left shin appeared. On admission, he was febrile and had tachycardia, and the mouth examination was consistent with bacterial pharyngitis. The left shin was grossly edematous, with diffuse bluish skin discoloration. Empiric antibiotic treatment with benzylpenicillin and clindamycin was started. An ultrasound scan of the left shin revealed extensive myonecrosis. Urgent fasciotomy was done, and necrotic muscles were surgically excised. Conclusions: Streptococcal necrotizing myositis is exceedingly rare. Due to potentially life-threatening complications and a need for urgent surgical intervention, clinicians must have a low threshold of suspicion, even in atypical pathogenesis and presentation. [ABSTRACT FROM AUTHOR]

Breadfruit marketing is limited by its rapid ripening and deterioration after harvest; therefore, improved postharvest practices may facilitate breadfruit marketing. This study examined the effect of harvest maturity and 1-methylcyclopropene (1-MCP) on the postharvest quality of 'Ma'afala' breadfruit (Artocarpus altilis). Breadfruit was harvested at 13, 15, and 17 weeks after flowering, and half of each harvest was treated with 1 lLL21 of 1-MCP for 20 hours. During storage, the weight of the fruit, hand feeling, skin color, respiration rate, and ethylene production rate were evaluated every other day until the fruit deteriorated. Compared with untreated fruit, 1-MCP treatment delayed the climacteric respiratory peak by 6 days (65% delay), delayed complete softening by 7 days (63% delay), and increased uniformity in the number of days to the climacteric respiratory peak and complete softening. Skin discoloration was delayed during the earliest harvest period by 5 days (108% delay). Picking breadfruit at early harvest maturity may be useful for preventing discoloration, and 1-MCP may be useful for preventing softening. [ABSTRACT FROM AUTHOR]

Abstract Background Breast hemangiomas are benign vascular lesion occurring within breast tissue. The main aim of this case report revolves around the importance of follow-up and excision of these benign lesions since they carry the risk of future malignancy. We report herein a histopathologically confirmed case of breast hemangioma diagnosed at routine sonomammogram. Case presentation A 58-year-old female presented with skin discoloration and vague mass in the lateral aspect of the left breast for one month. Physical examination, mammography and ultrasonography along with histopathological correlation have been carried out which helped us to arrive at the diagnosis of breast hemangioma. Conclusion For lesions with conclusive evidence of benignity in core needle biopsy, follow-up imaging is ideal and for those cases with atypical radiological and pathological findings, a complete surgical resection is mandatory in order to exclude the possibility of an underlying angiosarcoma.

Background: Dermatologic signs and symptoms can be the manifestations of a single disease or different diseases, and it is proven that some are associated with one another. These connections are not fully understood, but the answer lies in the pathophysiology of each disease. Case presentation: We report the case of a 6-year-old Middle-Eastern girl who presented with two skin lesions on the dorsum of her foot, along with scaling of her soles and palms, face skin discoloration, and areas of patchy alopecia on her scalp. She was diagnosed as a case of acute onset of granuloma annulare with alopecia areata and dermatitis. The treatment regimen for the patient's scalp consisted of topical minoxidil and betamethasone and three sessions with 1-month intervals of triamcinolone acetonide intralesional injections, which demonstrated modest effectiveness in treating alopecia areata. Conclusion: Granuloma annulare is a benign inflammatory illness with no known cause that might be difficult to cure. The clinical course and prognosis might vary greatly depending on the disease subtype, and associating symptoms and diseases, such as alopecia areata, should be considered. [ABSTRACT FROM AUTHOR]

Aquatic pollution may continue to deepen following the emergence of new class of toxicants. The present study investigated the effect of water-soluble fraction of burnt tire-ash on Clarias gariepinus. The fish were exposed to sublethal doses; 0.00 g/L, 2.24 g/L, 1.12 g/L and 0.56 g/L of tire-ash solution, representing 1/5, 1/10 and 1/20 of 11.2 g/L median lethal concentration (96 LC50), for 28 days, followed by 14 days recovery trial. Biological sampling was done on exposure day 1, 14 and 28, and on day14 recovery period for biochemical analysis such as the liver and gill Na+/K+ and Ca2+-ATPase, serum immunoglobulin (IgM) and brain acetylcholinesterase (AChE) of the experimental fish. Also, body biomass and behavior were evaluated. The behavioral responses exhibited by the fish to BTA exposure include reduced feeding, hypoactivity, air gulping and skin discoloration, which was observed to be concentration dependent. The body weight of 2.24 g/L and 1.12 g/L BTA-exposed fish decreased significantly than 0.56 g/L exposed fish and the control. Furthermore, findings revealed evident induction of Na+/K+ and Ca2 +-ATPase activities in both tissues, elevation of serum immunoglobulin content and inhibition of AChE activity in the brain of the exposed fish relative to the control. However, it was also observed that the biochemical parameters normalized after the recovery period. In conclusion, water-soluble fraction of burnt tire-ash produced toxicological effects in the experimental model, hence the present study provides the ecotoxicological insight of tire ash. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate a new surgical technique by the European Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) Study Group. Methods: This study included 391 patients (47 [(12%]) male and 344 [(88%)] female) who had undergone endoscopic thyroid or parathyroid surgery via the vestibular approach between February 2016 and May 2022 at nine centers. The data were analyzed with regard to complications, surgery time and specimen retrieval. Results: Overall, 376 (96.2%) TOETVA and 15 (3.8%) transoral endoscopic parathyroidectomy vestibular approach interventions were performed with an average surgery time of 145 (± 61.2) minutes and 509 nerves at risk. The specimens were retrieved via a transoral vestibular and retroauricular approach in 66 (16.9%) patients and via a transaxillary approach in 8 (2%). Benign histology including Grave's disease was identified in 272 (69.6%) patients, 1 (0.3%) presented noninvasive follicular thyroid neoplasms with papillary-like nuclear features, and 103 (26.3%) showed differentiated thyroid carcinoma. Solitary parathyroid adenoma were removed in 15 (3.8%) patients. Conversion to open surgery was necessary in 13 (3.3%) and revision had to be performed in 2 (0.5%) patients. Transient recurrent laryngeal nerve palsy (RLNP) was present in 18 (4.6%) and permanent RLNP in 2 (0.5%) patients. Fifteen (3.8%) patients experienced transient hypoparathyroidism after thyroidectomy. No case of permanent hypoparathyroidism was observed. Postoperative surgical site infection occurred in 1 (0.3%) patient. Despite a higher rate of sensory and motor disorders and skin discoloration at discharge, permanent disorders were present in only 3 (0.8%) and 16 (4.1%) patients, respectively. Conclusion: Our results show that transoral endoscopic surgery, performed by experienced endocrine surgeons, is a safe alternative to conventional thyroid surgery. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to demonstrate the effects of using a preparation containing kojic acid on skin hyperpigmentation using hyperspectral imaging, which enables a quantitative assessment of the effect of the preparation used on the reduction of skin discoloration. Materials and methods: Preliminary studies were carried out on 12 patients with post-acne skin. A hyperspectral camera with a spectral range of 400–1000 nm was used to image skin hyperpigmentation before and after the application of 3% kojic acid. Hyperspectral profiles were analyzed, and image analysis and processing methods were applied. Results: Studies performed using a hyperspectral camera have shown that kojic acid reduces skin discoloration by increasing skin brightness in 75% of patients tested, reducing skin contrast in approximately 83% and increasing skin homogeneity in approximately 67% of patients. [ABSTRACT FROM AUTHOR]

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