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International Journal of Molecular... Nov 2023The structure and function of infant skin is not fully developed until 34 weeks of gestation, and this immaturity is associated with risk of late-onset sepsis (LOS).... (Randomized Controlled Trial)
Randomized Controlled Trial
The structure and function of infant skin is not fully developed until 34 weeks of gestation, and this immaturity is associated with risk of late-onset sepsis (LOS). Topical coconut oil improves preterm-infant skin integrity and may reduce LOS. However, data on early-life skin-microbiome succession and potential effects of emollient skin care in preterm infants are scarce. We therefore collected skin-microbiome samples from the ear, axilla, and groin on days 1, 7, 14, and 21 from preterm infants born <30 weeks of gestation as part of a randomized clinical trial of standard skin care vs. topical coconut oil. We found that within-sample microbiome diversity was highest on day 1 after birth, with a subsequent decline and emergence of genus dominance from day 7. Moreover, microbiome assembly was less diverse in infants receiving coconut oil vs. standard skin care. Our study provides novel data on preterm-infant skin-microbiome composition and highlights the modifying potential of emollient skin care.
Topics: Infant; Infant, Newborn; Humans; Infant, Premature; Coconut Oil; Emollients; Skin; Sepsis; Microbiota
PubMed: 38068949
DOI: 10.3390/ijms242316626 -
Clinical and Experimental Allergy :... Oct 2023Recent discoveries have led to the suggestion that enhancing skin barrier from birth might prevent eczema and food allergy. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Recent discoveries have led to the suggestion that enhancing skin barrier from birth might prevent eczema and food allergy.
OBJECTIVE
To determine the cost-effectiveness of daily all-over-body application of emollient during the first year of life for preventing atopic eczema in high-risk children at 2 years from a health service perspective. We also considered a 5-year time horizon as a sensitivity analysis.
METHODS
A within-trial economic evaluation using data on health resource use and quality of life captured as part of the BEEP trial alongside the trial data. Parents/carers of 1394 infants born to families at high risk of atopic disease were randomised 1:1 to the emollient group, which were advised to apply emollient (Doublebase Gel or Diprobase Cream) to their child at least once daily to the whole body during the first year of life or usual care. Both groups received advice on general skin care. The main economic outcomes were incremental cost-effectiveness ratio (ICER), defined as incremental cost per percentage decrease in risk of eczema in the primary cost-effectiveness analysis. Secondary analysis, undertaken as a cost-utility analysis, reports incremental cost per Quality-Adjusted Life Year (QALY) where child utility was elicited using the proxy CHU-9D at 2 years.
RESULTS
At 2 years, the adjusted incremental cost was £87.45 (95% CI -54.31, 229.27) per participant, whilst the adjusted proportion without eczema was 0.0164 (95% CI -0.0329, 0.0656). The ICER was £5337 per percentage decrease in risk of eczema. Adjusted incremental QALYs were very slightly improved in the emollient group, 0.0010 (95% CI -0.0069, 0.0089). At 5 years, adjusted incremental costs were lower for the emollient group, -£106.89 (95% CI -354.66, 140.88) and the proportion without eczema was -0.0329 (95% CI -0.0659, 0.0002). The 5-year ICER was £3201 per percentage decrease in risk of eczema. However, when inpatient costs due to wheezing were excluded, incremental costs were lower and incremental effects greater in the usual care group.
CONCLUSIONS
In line with effectiveness endpoints, advice given in the BEEP trial to apply daily emollient during infancy for eczema prevention in high-risk children does not appear cost-effective.
Topics: Humans; Infant; Cost-Effectiveness Analysis; Dermatitis, Atopic; Eczema; Emollients; Quality of Life; Treatment Outcome
PubMed: 37574761
DOI: 10.1111/cea.14381 -
CytoJournal 2023Even though fine-needle aspiration cytology (FNAC) can be successfully used for describing the cytomorphology of skin adnexal tumors and can help in identification of...
OBJECTIVES
Even though fine-needle aspiration cytology (FNAC) can be successfully used for describing the cytomorphology of skin adnexal tumors and can help in identification of them as benign or malignant, histopathology remains the gold standard in confirmation of diagnosis. Skin adnexal tumors are a large and diverse group and are relatively less commonly encountered in routine practice; hence, knowledge of cytological features of these lesions is crucial for their appropriate management. The present study aims to evaluate the cytomorphological features of skin adnexal tumors on FNAC smears and their correlation with the histopathology.
MATERIAL AND METHODS
This is a retrospective study of FNAC of 60 cases of subcutaneous and dermal swellings over a period of 4 years from August 2018 to August 2022 in a tertiary care center.
RESULTS
In the 60 cases of skin adnexal tumors evaluated, most cases were within the 2 to 4 decade with male predominance. The FNA smears were helpful in picking up the nature of skin adnexal tumors, as in our case series, malignant lesions were 8.3% and benign were 91.7%. Majority adnexal lesions were of follicular or sebaceous differentiation. Histological diagnosis was available in 38 cases. Cytological diagnosis in 34 cases was concordant with histopathology. There was discrepancy observed in two cases which were reported as benign skin adnexal tumor but later turned out to be sebaceous carcinoma on histopathology.
CONCLUSION
Even though histopathology being the gold standard for confirmation of diagnosis, in the current era of minimally invasive procedures, FNAC stands out as a valuable modality and can be a promising alternative to diagnose skin adnexal tumors and understand their cytomorphology as the data are limited about it.
PubMed: 37942303
DOI: 10.25259/Cytojournal_19_2023 -
BMC Women's Health Nov 2023The management of preterm births remains a major challenge in Madagascar, given the lack of equipped facilities in rural areas, and the absence of precise data...
The management of preterm births remains a major challenge in Madagascar, given the lack of equipped facilities in rural areas, and the absence of precise data concerning the incidence of such births. The World Health Organization (WHO) recommends the kangaroo method (skin-to-skin contact) for the management of preterm infants. In this article, we examine the conditions for success and the obstacles facing kangaroo care in community settings in Madagascar. We performed a qualitative research, collecting data from the districts of Antananarivo and Mahajanga in 2021. In total, 54 semi-structured interviews and two focus group sessions were conducted with the parents of preterm infants and healthcare professionals.The obstacles identified by the research included incomplete and inaccurate knowledge, leading to heterogeneity in the practice of kangaroo care: arbitrary duration, lack of kangaroo care at night, exclusive breastfeeding, and only partially practiced skin-to-skin contact. We found that the conditions for success depended on: (1) the healthcare system, (2) local interpretations of pregnancy, and (3) the structure of the infant's family. Failings of the medical system, cultural habits going against kangaroo care, and "nuclear" and/or "single parent" family structures undermine the application of this practice, jeopardizing upscaling efforts. We hope that the results of this research will guide community strategies for the management of preterm infants and kangaroo care.
Topics: Female; Humans; Infant; Infant, Newborn; Pregnancy; Breast Feeding; Infant, Premature; Kangaroo-Mother Care Method; Madagascar; Qualitative Research
PubMed: 37996854
DOI: 10.1186/s12905-023-02781-7 -
Journal of Multidisciplinary Healthcare 2023Incontinence-Associated Dermatitis is a serious skin injury causing suffering, secondary infection, and inducing almost six times more pressure sore than normal skin... (Review)
Review
BACKGROUND
Incontinence-Associated Dermatitis is a serious skin injury causing suffering, secondary infection, and inducing almost six times more pressure sore than normal skin patients. This moisture and chemical skin irritation is a concern, especially for intensive care unit nurses. This study aimed to review the effective nursing strategy for preventing and caring for incontinence-associated dermatitis in older intensive care unit patients and pilot its feasibility.
METHODS
The five databases, including PubMed, Google Scholar, CINAHL Complete, WanFang, and CNKI, were searched, and articles were screened and extracted. The strategies and details of prevention and care for incontinence-associated dermatitis were reviewed and summarized. Finally, selected strategies were applied to five intensive care unit patients with various health conditions and levels of Incontinence-Associated Dermatitis severity.
RESULTS
The literature review found that there is a standardized nursing process for incontinence-associated dermatitis. The prevention and care strategies for incontinence-associated dermatitis include assessment, risk factor management, skin cleaning, skin protection, and health education and training. In actual clinical application, personalized nursing measures can positively impact patients. Five case studies from our pilot confirmed this finding.
CONCLUSION
Personalized nursing measures can positively impact patients in actual clinical applications. Our five case studies implementing the strategies from the review confirmed this finding. In clinical work, it is recommended to develop personalized nursing programs for specific risk factors of older intensive care unit patients.
PROTOCOL REGISTRATION
TCTR20230808004.
PubMed: 37954467
DOI: 10.2147/JMDH.S434275 -
Journal of Tissue Viability May 2024The aim of the study was to describe types and frequencies of skin care interventions and products provided in institutional long-term care. (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
The aim of the study was to describe types and frequencies of skin care interventions and products provided in institutional long-term care.
MATERIALS AND METHODS
Baseline data from a cluster randomized controlled trial conducted in nursing homes in Berlin, Germany was collected before randomization. Numbers, proportions and frequencies of washing, showering and bathing, and the application of leave-on products were calculated. Product labels were iteratively and inductively categorized into overarching terms and concepts.
RESULTS
A total of n = 314 residents participated in the study. In the majority, washing of the whole body was done once daily, and showering was performed once per week or more rarely. The majority received leave-on products daily on the face and once per week on the whole body. Most of the skin care interventions were delivered by nurses. There was marked heterogeneity in terms of product names, whereas the product names reveal little about the ingredients or composition.
CONCLUSION
Personal hygiene and cleansing interventions are major parts of clinical practice in long-term care. Daily washing is a standard practice at the moment. In contrast, leave-on products are used infrequently. To what extent the provided care promotes skin integrity is unclear. Due to the heterogeneity and partly misleading labels of skin care products, informed decision making is difficult to implement at present.
GOV IDENTIFIER
NCT03824886.
Topics: Humans; Cross-Sectional Studies; Skin Care; Female; Long-Term Care; Male; Germany; Aged, 80 and over; Aged; Nursing Homes
PubMed: 38360494
DOI: 10.1016/j.jtv.2024.02.005 -
Indian Dermatology Online Journal 2024Pediatric dermatitis seborrhoica (DS) is a common inflammatory disorder of infancy and adolescence distinct from atopic dermatitis. We performed a narrative review on... (Review)
Review
Pediatric dermatitis seborrhoica (DS) is a common inflammatory disorder of infancy and adolescence distinct from atopic dermatitis. We performed a narrative review on clinical and therapeutic aspects of the disease. The prevalence varies geographically and can reach up to 10%. There is a slight male predominance. Although etiopathology is not well known, both endogenous and exogenous factors contribute. Skin microbiome and its interaction with sebaceous gland function is crucial. The inflammatory pathways include innate immune function and skin barrier disturbances. spp. and certain bacteria are increased in lesional skin. DS develops in different clinical subtypes, from localized cephalic to disseminated disease with a risk of erythroderma and eczema herpeticatum. Treatment consists of skin care and topical and rarely systemic medical therapy. Cornerstones of treatment are antifungals and mild corticosteroids. Targeted treatment is on the horizon. Pediatric DS is a common disorder important in the differential diagnosis of skin problems in infants and and children. Due to better understanding of its pathogenesis, new treatment options are developed.
PubMed: 38845676
DOI: 10.4103/idoj.idoj_593_23