ABSTRACT Preserving the great saphenous vein during inguinal lymph node dissection maintains venous outflow and skin drainage while allowing complete oncologic clearance.
Background Keloids are a prevalent pathological fibrotic and proliferative disorder characterized by persistent inflammation and immune dysregulation. In recent years, the critical role of immune cells in keloid development and progression has attracted increasing attention.Objective To summarize the immunoregulatory mechanisms and immune dysfunction involved in keloids and to discuss therapeutic strategies targeting these pathways.Methods Relevant evidence on immune cell populations and immunoregulatory pathways implicated in keloid pathogenesis was reviewed, with emphasis on regulatory T cells, macrophages, dendritic cells, myeloid-derived suppressor cells, CD8+ T cells, and natural killer cells.Results Regulatory immune cells, particularly regulatory T lymphocytes (Tregs), exert important effects on keloid formation. Tregs secrete cytokines such as transforming growth factor-beta (TGF-β) and interleukin-10 (IL-10), which suppress inflammation while promoting fibroblast hyperproliferation. M2 macrophages are the predominant macrophage subtype in keloid tissue and contribute to extracellular matrix deposition through the secretion of anti-inflammatory and pro-fibrotic factors. In addition, keloids may exhibit an immune milieu characterized by enrichment of canonical immunoregulatory populations, including regulatory T cells, tolerogenic dendritic cells, and myeloid-derived suppressor cells, together with impaired cytotoxic immune activity involving dysfunctional or exhausted CD8+ T cells and natural killer cells. These alterations collectively support an anti-inflammatory yet pro-fibrotic microenvironment that favors keloid persistence and progression.Conclusion Immunoregulatory mechanisms and cytotoxic immune dysfunction are central to keloid pathogenesis. Targeting these pathways may provide a basis for the development of novel immunomodulatory strategies to improve keloid outcomes.
ABSTRACT Background and Aims Acne is a major health problem among adolescents. There is little published epidemiological data on the association between acne and body mass index (BMI) among adolescents, and no study has been conducted in Sudan. We aimed to assess the prevalence of acne and the possible associated factors (including body mass index [BMI]) among adolescent schoolchildren in the River Nile in Sudan. Methods A cross‐sectional survey was conducted among adolescents (males and females) during the 3‐month period (July–September 2022). A questionnaire was used to collect sociodemographic information, and their BMIs were computed from their weights and heights, which were measured using a standard procedure. Multivariate binary regression analysis was conducted. Results Of the 384 enrolled adolescents, 177 (46.1%) were males and 297 (53.9%) were females. The median (interquartile) of the age and BMI were 15.1 (14.0–16.3) years and 18.4 (16.4–21.5) kg/m2, respectively. One hundred and forty adolescents (36.5%) had acne, which was mild in 109 (28.4%), moderate in 28 (7.3%), and severe in three (0.8%) adolescents. After adjusting, age (adjusted odds ratio (AOR) = 1.21, 95% confidence interval, CI = 1.04–1.41) and BMI (AOR = 1.10, 95% CI = 1.01‒1.14) were positively associated with acne. Females were at a higher risk of having acne (AOR = 2.59, 95% CI = 1.64‒4.08). Conclusion Our results showed a high prevalence of acne among Sudanese adolescents, especially females, and its prevalence increased with age and BMI.
Songdi Zhang,* Lijuan Zhang,* Aikedai Yusufu,* Hadiliya Hasimu, Xiaodong Wang, Paride Abliz Department of Dermatology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xiaodong Wang; Paride Abliz, Department of Dermatology, The First Affiliated Hospital of Xinjiang Medical University, No. 393, Xinyi Road, Urumqi, Xinjiang, People’s Republic of China, Email zhengdong18@sina.com; plida1116@163.comObjective: This study aims to investigate the clinical distribution characteristics and drug susceptibility profiles of invasive Candida isolates in a tertiary hospital in Urumqi.Methods: The examination was conducted on samples obtained from patients who were clinically diagnosed with invasive candidiasis in this hospital. A total of 109 strains of Candida strains were identified through the use of internal transcribed spacer (ITS) sequencing and fungal cultivation methods.The clinical distribution of the strains was analyzed. Antifungal drug susceptibility tests were performed using the Sensititre YO10 fungal drug susceptibility plate based on the micro-broth dilution method.Results: Candida albicans had the highest percentage (51.38%) among 109 Candida isolates, followed by C. glabrata (18.35%) and C. tropicalis (15.60%). The isolates were predominantly found in the respiratory department (41.28%), intensive care unit (ICU) (31.19%), and infection department (9.17%).The results of drug susceptibility tests indicated that amphotericin B, 5-fluorocytosine, and echinocandins exhibited good in vitro antifungal activity, with a susceptibility rate of over 96%. However, the azoles demonstrated low antifungal activity, especially posaconazole and voriconazole, which had high resistance rates of 64.71% for C. tropicalis and 70% for C. glabrata, respectively.Conclusion: In our hospital, Candida albicans was identified as the primary causal agent of invasive candidiasis. In terms of in vitro antifungal activity, echinocandins, amphotericin B, and 5-fluorocytosine demonstrated efficacy against invasive Candida infections. However, it was important to note that C. glabrata and C. tropicalis exhibited low susceptibility to azoles. Keywords: Candida isolates, clinical distribution, antifungal drug susceptibility tests, drug resistance
May El Hachem, Andrea Diociaiuti, Giovanna Zambruno
et al.
Abstract Background Inherited epidermolysis bullosa (EB) is a clinically and genetically heterogeneous group of skin fragility disorders characterized by blister formation following minor trauma. Four major types are distinguished based on the level of cleavage within the skin. Most EB forms present severely disabling cutaneous and systemic signs and symptoms. Management relies on daily time-consuming and distressing topical medications, and symptomatic treatment of systemic findings. Disease manifestations, symptoms, and daily care strongly affect patient and caregiver quality of life (QoL). To date, there are two validated EB-specific questionnaires, the “Quality of Life in Epidermolysis Bullosa” (QOLEB) and the “Epidermolysis Bullosa Burden of Disease” (EB-BoD) for the evaluation of patient and family disease burden, respectively. The aim of our study was to develop an Italian translation of the two questionnaires and to pilot-test them. Methods The guidelines for translation and cross-cultural adaptation of health-related QoL measures were followed. Initially, two separate translations were generated for each questionnaire, and subsequently reconciled by an expert committee. This was followed by a back-translation process. The original texts and all translations underwent revision by the expert committee, resulting in definitive versions. The final versions were then tested in a pilot study involving cognitive debriefing in a group of 17 families, representative of all EB major types. Results The translation and reconciliation process led to minor changes to obtain semantic/idiomatic/cultural equivalence of the Italian versions with the original ones and to reconcile the questions with the answer options. The cognitive debriefing process showed a good understanding and did not require text modifications. Conclusions The Italian versions of the QOLEB and EB-BoD provide valuable tools in everyday clinical practice of reference centers, and they allow the participation in multicenter international real-life observational studies as well as in controlled clinical trials. They enable the identification of disease-specific psychological and socioeconomic challenges for EB patients and their families, guiding targeted interventions to ensure appropriate and timely care.
Azusa Saika, Azusa Saika, Takahiro Nagatake
et al.
Intestinal bacteria metabolize dietary substances to produce bioactive postbiotics, among which some are recognized for their role in promoting host health. We here explored the postbiotic potential of two omega-3 α-linolenic acid–derived metabolites: trans-10-cis-15-octadecadienoic acid (t10,c15-18:2) and cis-9-cis-15-octadecadienoic acid (c9,c15-18:2). Dietary intake of lipids rich in omega-3 α-linolenic acid elevated levels of t10,c15-18:2 and c9,c15-18:2 in the serum and feces of mice, an effect dependent on the presence of intestinal bacteria. Notably, t10,c15-18:2 mitigated skin inflammation in mice that became hypersensitive after exposure to 2,4-dinitrofluorobenzene, an experimental model for allergic contact dermatitis. In particular, t10,c15-18:2—but not c9,c15-18:2—attenuated ear swelling and edema, characteristic symptoms of contact hypersensitivity. The anti-inflammatory effects of t10,c15-18:2 were due to its ability to suppress the release of vascular endothelial growth factor A from keratinocytes, thereby mitigating the enhanced vascular permeability induced by hapten stimulation. Our study identified retinoid X receptor as a functional receptor that mediates the downregulation of skin inflammation upon treatment with t10,c15-18:2. Our results suggest that t10,c15-18:2 holds promise as an omega-3 fatty acid–derived postbiotic with potential therapeutic implications for alleviating the skin edema seen in allergic contact dermatitis–induced inflammation.
Sophie Cottin, Virginie Doyen, Charles Pilette
et al.
Asthma is a heterogeneous disease sharing airway instability but with different biology, risk factors, and response-to-therapy patterns. Biologics have revolutionized the one-size-fits-to-all approach to personalized medicine in severe asthma (SA), which relies on the identification of biomarkers that define distinct endotypes. Thus, blood eosinophils and, to some extent, exhaled nitric oxide (FeNO) can predict the response to approved anti-type 2 (T2) biologics (anti-IgE, anti–IL-5, and anti–IL-4R alpha), whereas age at onset and comorbidities such as anxiety/depression, obesity, reflux, and upper airway disease (UAD) also influence therapeutic responses in SA. In this article, focusing on the predictive value of biomarkers for the therapeutic response to biologics in SA, we first summarize the level of prediction achieved by T2 biomarkers (blood eosinophils, FeNO) and then review whether data support the predictive value of upper airway diagnosis on such outcomes. Post hoc analysis of most studies with T2 biologics suggests that chronic rhinosinusitis with nasal polyps (CRSwNP) and, to a lower extent, allergic rhinitis may help in predicting clinical response. Considering that T2 biologics are now also approved for the treatment of severe CRSwNP, diagnosis of upper airway disease is a key step in determining eligibility for such therapy.
Eva Krishna Sutedja, Rafithia Anandita, Endang Sutedja, Inne Arline Diana, Kartika Ruchiatan Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital, Bandung, West Java, IndonesiaCorrespondence: Eva Krishna Sutedja, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital, Jl. Pasteur No. 38, Bandung, West Java, 40161, Indonesia, Tel +628122014300, Email evakrishna@yahoo.comAbstract: Spiradenoma is a rare benign adnexal tumor with eccrine differentiation. The clinical manifestations include painful, skin-colored, red, gray, or bluish nodules on the upper half of the body. We report a case of spiradenoma in a 31-year-old man. The diagnosis was established from the patient’s history, physical examination, and histopathological examination. In this case, the patient was treated with intralesional injection of triamcinolone acetonide (TA) 10 mg/mL. After the fourth injection, the lesions grew smaller and thinner. TA injection is easy to administer and showed good efficacy in spiradenoma case, although further research with a larger number of patients is needed.Keywords: adnexal tumor, eccrine glands, rare case, spiradenoma, triamcinolone acetonide injection
Background/Aims: Adropin is a metabolic hormone secreted by the liver, brain, and many peripheral tissues and is involved in energy homeostasis and insulin sensitivity. Some reports have indicated a significant decrease in serum adropin levels in type 2 diabetic patients. However, the significance of a decline in adropin level in early detection of diabetic nephropathy (DN) remains to be clarified. The purpose of this study was to evaluate the serum levels of adropin in patients with type 2 diabetes with and without nephropathy. Methods: A total of 135 unrelated subjects (including 45 diabetic patients with nephropathy, 45 without nephropathy, and 45 healthy controls) were enrolled in this study. Fasting venous blood samples were collected from all patients. Serum adropin levels of all cases were analyzed by an enzyme-linked immunosorbent assay method. The correlations of serum adropin levels with anthropometric and biochemistry variables were determined. Logistic regression was performed to assess the association of adropin with odds of nephropathy. A receiver operating characteristic (ROC) curve was obtained to explore the optimum serum adropin concentration in distinguishing diabetic patients with and without nephropathy. Results: Diabetic patients with nephropathy showed lower serum adropin levels than those in patients without nephropathy and healthy controls (p < 0.001). Pearson correlation analysis indicated that serum adropin was negatively correlated with BMI, FBS, HbA1c, blood urea, creatinine, LDL, and ACR and positively correlated with HDL and albumin. Logistic regression analysis showed that serum adropin was correlated with decreased risk of developing diabetic nephropathy. Moreover, in ROC analysis, at cutoff value 3.20 (mg/dL) with an AUC = 0.830, adropin had 80% sensitivity and 60% specificity for distinguishing the diabetic nephropathy. Conclusions: This study demonstrates that decreased level of adropin is associated with renal dysfunction in patients with type 2 diabetes mellitus. Serum adropin concentrations may be used as a biomarker for early detection of diabetic nephropathy.
Dermatology, Diseases of the circulatory (Cardiovascular) system
BackgroundTumor-infiltrating lymphocytes (TILs) are considered a manifestation of the host immune response against cancer and tertiary lymphoid structures (TLS) may contribute to lymphocytes recruitment. Both of them have been reported as potential prognostic parameters in some human malignancies. However, the roles of TILs, TLS, and their correlation in Epstein-Barr Virus-associated gastric carcinoma (EBVaGC) and EBV-negative gastric carcinoma (EBVnGC) are largely unknown.MethodsTo observe the correlation among TILs, TLS, and clinicopathological characteristics and their prognostic significance in EBVaGC and EBVnGC, respectively. TILs and TLS were assessed by morphology and/or immunohistochemistry, and accompanied by clinicopathological analysis from 846 gastric cancer patients in multiple institutions.ResultsForty-two (5.0%) cases of EBVaGC and 804 cases of EBVnGC were identified by in situ hybridization, respectively. For EBVnGC, higher TILs grade was correlated with TLS-present. EBVnGC patients with high TILs grade and TLS-present exhibited survival benefits. TILs (P = 0.001) and TLS (P = 0.003), especially TILs & TLS (P < 0.001) were independent prognostic factors in EBVnGC. A nomogram was constructed and validated for predicting the probability of overall survival and performed well with a good calibration. No significant prognostic value was detected in EBVaGC.ConclusionTILs and TLS, especially TILs & TLS were promising prognostic indicators for overall survival in EBVnGC. TILs and TLS were highly overlapping in their extent and prognostic abilities, and may be considered as a coindicator of prognosis of gastric cancer. The evaluations of TILs and TLS are simple and can be assessed routinely in pathological diagnosis.
Abstract. Objective:. Androgenetic alopecia (AA) is a progressive hair loss disorder mediated by systemic androgens and genetic factors. A variety of AA treatments have been investigated. Currently, there is emerging evidence and growing interest in the use of platelet-rich plasma (PRP) for AA. This study describes a single-center experience using PRP to treat AA in women.
Methods:. A retrospective observational study design was employed. The study cohort comprised 20 women >18 years of age who were diagnosed with AA. PRP was prepared using a commercially available PRP kit. Each patient received six PRP treatment sessions at 4-week intervals. The severity of alopecia tool (SALT) scoring system was used to measure the severity of alopecia, and a paired t-test was used to calculate significance levels.
Results:. The mean pre-intervention and post-intervention total SALT score was 27.5 ± 6.35 and 9.41 ± 3.71, respectively. The difference in the total mean SALT score was 18.33 ± 1.64 and the effect size was 3.52. The scalp area with the largest effect size was the vertex (Cohen d = 2.53). The effect size was similar across other scalp areas (Cohen d = 1.91–2.09). There were no serious adverse effects of the treatment; only mild transient adverse effects were reported.
Conclusion:. The present study demonstrated the efficacy and safety of PRP injections in treating AA in women. However, these findings require confirmation in well-designed studies using standardized treatment protocols and evaluation methods.
Leena Chularojanamontri, Natchaya Junsuwan, Narumol Silpa-archa
et al.
Objective: To assess the clinical utility of the Psoriasis Epidemiology Screening Tool (PEST), the Early Arthritis for Psoriatic Patients (EARP) questionnaire, and the Siriraj Psoriatic Arthritis Screening Tool (SiPAT) as screening tools for psoriatic arthritis (PsA), and to identify factors significantly associated with PsA.
Methods: This cross-sectional study included adult psoriasis patients who attended the outpatient clinic at Siriraj Hospital and had not been diagnosed with PsA during 1 March 2017 to 28 February 2018. Participants completed the EARP, PEST, and SiPAT, after which musculoskeletal history was taken, and examination and radiography were performed. Diagnosis of PsA was based on Classification Criteria for Psoriatic Arthritis. Receiver operator characteristic (ROC) curves, sensitivity, and specificity were used to determine assessment tool performance. Logistic regression analysis was used to identify factors associated with PsA.
Results: Eighty-seven patients with a mean age of 45.90±14.75 years were enrolled. Twenty-six (29.88%) patients were diagnosed as PsA. According to ROC values, EARP had the best discriminative power (0.83) for distinguishing between psoriatic patients with and without PsA (SiPAT: 0.78, PEST: 0.77). SiPAT had the highest sensitivity (92.3%), followed by EARP (84.6%) and PEST (50.0%); whereas, PEST had the highest specificity (82.0%), followed by EARP (62.3%) and SiPAT (54.1%) for detecting PsA. Multivariate analysis revealed body surface area involvement >10% to be the only independent predictor of PsA (OR: 2.99, 95% CI: 1.09-8.21).
Conclusion: SiPAT is an effective and simple to use tool for screening PsA in psoriasis patients. Body surface area involvement >10% is a significant predictor of PsA.
Thuraya Ahmed Albadr, Danah Khalid Alruhaimi, Peter M B. Cahusac
et al.
Background: The most effective treatment for severe acne is isotretinoin. However, it carries major side effects, such as teratogenicity, depression, and increased lipid profiles. It is advised to monitor the lipid profile and to use two forms of contraception during isotretinoin use. Although it is commonly prescribed, little data are available regarding patients' understanding of isotretinoin. Objectives: The aim of this study is to assess Saudi female college students' knowledge about isotretinoin use and side effects. Methods: Data were collected by a validated online questionnaire disseminated through social media, allowing the collection of information from students from different regions of the country. Results: The total number of responses was 622. The majority of respondents were 18–24 years old, single, and college students; all were female. About 48.6% (282) of the sample used isotretinoin. Most had good knowledge of isotretinoin side effects. Medical students were more knowledgeable than students of other majors, and users were more knowledgeable than nonusers. The most common side effect was dryness. Use among married females was 2.8%, the majority of whom were instructed by their physicians to use only one method of contraception. One respondent got pregnant while using the drug. Conclusion: College-aged females generally have good knowledge of isotretinoin and its side effects. However, awareness about proper contraceptive use while on the drug is lacking.
The field of dermatology, and pigmentary disorders, specifically, has undergone a sea of positive changes since the turn of this millennium. The flip side to this change has been the influx of law into the realms of dermatology. Ego medicolegal issues are on the rise, caused by a variety of factors: the rise of interventional procedures, overpromising and underdelivering by physicians, quackery, and Internet awareness, to name but a few. Needless to say, a dermatology practitioner today will most likely be introduced to the medicolegal world, given the increased incidence of the aforementioned. And it is common knowledge that medical schools and residency colleges do not cater to these specific needs of medicolegal education even though serious efforts are being made to bridge this gap.
Abstract Capillary malformation-arteriovenous malformation (CM-AVM) is a clinical entity newly identified in 2003 that is caused by mutation of the RASA-1 gene, which encodes the protein p120-RasGAP. To date, most of the clinical reports on CM-AVM in the literature involve samples entirely consisting of Caucasians of European and North American descent, while reports from China or East Asia are few. Here, we describe a genetic clinical report of CM-AVM. Sequencing revealed a novel stop mutation in the RASA-1 gene causing loss of function (LOF) of the RasGAP domain. To our knowledge, this is the first genetic clinical report of a CM-AVM patient in East Asia. This report may extend our understanding and support further studies of CM-AVM in East Asia.