-
International Medical Case Reports... 2024We report a case of Carmi Syndrome in a neonate.
OBJECTIVE
We report a case of Carmi Syndrome in a neonate.
AIM
To share our lessons in diagnosis of the case of Carmi Syndrome.
CASE REPORT
Carmi Syndrome is an extremely rare autosomal recessive genetic disorder characterized the coexistence of pyloric atresia and junctional epidermolysis bullosa, and with aplasia cutis congenita in approximately 28% patients. In this case, a full-term male neonate was born to a GPL multipara through cesarean section delivery in hospital in a non-consanguineous marriage with 4000mL of II°meconium-stained amniotic fluid. He was found extensive skin loss over lower legs and other parts, with scattered blisters and bilateral microtia. Plain abdominal X-ray revealed a large gastric air bubble with no gas distally. The mother had an intrauterine fetal loss previously for reasons unknown. The dermatologist diagnosed the newborn with Bart Syndrome, while the pediatric surgeon diagnosed congenital pyloric atresia(CPA). The parents refused further treatment and the neonate passed away about 30 hours after birth.
OUTCOME
The neonate passed away about 30 hours after birth.
CONCLUSION
Lessons from this case:①.Rule out Carmi Syndrome in patients with PA, and differentiate Bart syndrome and Carmi Syndrome in patients with abnormal skin manifestations. ②. For rare and/or severe diseases, multidisciplinary teams(MDTs) should be establish. ③. Genetic counseling and prenatal diagnosis are necessary prior to subsequent childbearings. ④.Termination of pregnancy might be contemplated if certain indicators are revealed.
PubMed: 38784139
DOI: 10.2147/IMCRJ.S354337 -
Digital Health 2024The study aimed to propose a multimodal model that incorporates both macroscopic and microscopic images and analyze its influence on clinicians' decision-making with...
OBJECTIVES
The study aimed to propose a multimodal model that incorporates both macroscopic and microscopic images and analyze its influence on clinicians' decision-making with different levels of experience.
METHODS
First, we constructed a multimodal dataset for five skin disorders. Next, we trained unimodal models on three different types of images and selected the best-performing models as the base learners. Then, we used a soft voting strategy to create the multimodal model. Finally, 12 clinicians were divided into three groups, with each group including one director dermatologist, one dermatologist-in-charge, one resident dermatologist, and one general practitioner. They were asked to diagnose the skin disorders in four unaided situations (macroscopic images only, dermatopathological images only, macroscopic and dermatopathological images, all images and metadata), and three aided situations (macroscopic images with model 1 aid, dermatopathological images with model 2&3 aid, all images with multimodal model 4 aid). The clinicians' diagnosis accuracy and time for each diagnosis were recorded.
RESULTS
Among the trained models, the vision transformer (ViT) achieved the best performance, with accuracies of 0.8636, 0.9545, 0.9673, and AUCs of 0.9823, 0.9952, 0.9989 on the training set, respectively. However, on the external validation set, they only achieved accuracies of 0.70, 0.90, and 0.94, respectively. The multimodal model performed well compared to the unimodal models, achieving an accuracy of 0.98 on the external validation set. The results of logit regression analysis indicate that all models are helpful to clinicians in making diagnostic decisions [Odds Ratios (OR) > 1], while metadata does not provide assistance to clinicians (OR < 1). Linear analysis results indicate that metadata significantly increases clinicians' diagnosis time ( < 0.05), while model assistance does not ( > 0.05).
CONCLUSIONS
The results of this study suggest that the multimodal model effectively improves clinicians' diagnostic performance without significantly increasing the diagnostic time. However, further large-scale prospective studies are necessary.
PubMed: 38784049
DOI: 10.1177/20552076241257087 -
BMC Health Services Research May 2024Difficulty obtaining a dermatological consultation is an obstacle to the early diagnosis of melanoma. On the one hand, patients survival depends on the lesion thickness... (Randomized Controlled Trial)
Randomized Controlled Trial
Early diagnosis of melanoma: a randomized trial assessing the impact of the transmission of photographs taken with a smartphone from the general practitioner to the dermatologist on the time to dermatological consultation.
BACKGROUND
Difficulty obtaining a dermatological consultation is an obstacle to the early diagnosis of melanoma. On the one hand, patients survival depends on the lesion thickness at the time of diagnosis. On the other hand, dermatologists treat many patients with benign lesions. Optimizing patient care pathways is a major concern. The aim of the present study was to assess whether the e-mail transmission of photographs of suspected melanoma lesions between general practitioners (GPs) and dermatologists reduces the time to dermatological consultation for patients whose suspicious skin lesions ultimately require resection.
METHODS
We conducted a cluster-randomized controlled study in primary care involving 51 French GPs between April 2017 and August 2019. A total of 250 patients referred to a dermatologist for a suspected melanoma lesion were included GPs were randomized to either the smartphone arm or the usual care arm. In the smartphone arm, the GPs referred patients to the dermatologist by sending 2 photographs of the suspicious lesion using their smartphone. The dermatologist then had to set up an appointment at an appropriate time. In the usual care arm, GPs referred patients to a dermatologist according to their usual practice. The primary outcome was the time to dermatological consultation for patients whose lesion ultimately required resection.
RESULTS
57 GPs volunteered were randomized (27 to the smartphone arm, and 30 to the usual care arm). A total of 125 patients were included in each arm (mean age: 49.8 years; 53% women) and followed 8 months. Twenty-three dermatologists participated in the study. The time to dermatological consultation for patients whose suspicious skin lesion required resection was 56.5 days in the smartphone arm and 63.7 days in the usual care arm (mean adjusted time reduction: -18.5 days, 95% CI [-74.1;23.5], p = .53).
CONCLUSIONS
The e-mail transmission of photographs from GPs to dermatologists did not improve the dermatological management of patients whose suspicious skin lesions ultimately required resection. Further research is needed to validate quality criteria that might be useful for tele-expertise in dermatology.
TRIAL REGISTRATION
Registered on ClinicalTrials.gov under reference number NCT03137511 (May 2, 2017).
Topics: Humans; Melanoma; Female; Smartphone; Male; Middle Aged; Photography; General Practitioners; Skin Neoplasms; Early Detection of Cancer; Referral and Consultation; Adult; Dermatologists; Aged; Time Factors; France; Early Diagnosis
PubMed: 38783296
DOI: 10.1186/s12913-024-11106-9 -
The Journal of Clinical and Aesthetic... May 2024Seborrheic dermatitis (SD) is a chronic inflammatory skin condition that commonly involves the scalp, and thus, affects a diverse demographic with varying hair care...
Seborrheic dermatitis (SD) is a chronic inflammatory skin condition that commonly involves the scalp, and thus, affects a diverse demographic with varying hair care needs. Current SD treatments are limited based on optimized formulation, efficacy, adverse events, and lack of placebo-controlled trials. A novel roflumilast foam formulation has emerged as a promising therapeutic option optimally designed for use on the scalp and other hair-bearing areas. We conducted a comprehensive assessment of beauty industry standards, confirming the foam formulation's alignment with industry guidelines and exclusion of potentially harmful ingredients. In addition, consultation with an expert dermatologist panel yielded a strong endorsement, underscoring a high level of confidence in prescribing the foam across diverse hair and skin types.
PubMed: 38779376
DOI: No ID Found -
The Journal of Clinical and Aesthetic... May 2024Gender nonconformity refers to individuals whose gender identity, roles, or expressions do not adhere to societal standards and norms. Affirmative care is an approach to...
OBJECTIVE
Gender nonconformity refers to individuals whose gender identity, roles, or expressions do not adhere to societal standards and norms. Affirmative care is an approach to healthcare delivery in which organizations, programs, and providers recognize, validate, and support the identity stated or expressed by the individuals served. This study examined the effects of nonsurgical interventions performed by dermatologists, specifically botulinum toxins (BoNTA) and dermal filler injections, on the physical and mental health of Filipino gender nonconforming individuals.
METHODS
Six gender nonconforming patients received filler and BoNTA injections to enhance their desired facial features. The patients were interviewed before and three months after the treatment session. Baseline and three months posttreatment photos were used to examine treatment results, including the facial width-to-height ratio (FWHR). Three months after treatment, the patients answered a five-question Likert-scale satisfaction survey.
RESULTS
Patients reported high satisfaction with the treatment outcomes (median=5) and agreed that the treatment met their expectations (median=5). They reported improved fine lines and wrinkles (median=5) and increased self-confidence (median=5). All participants strongly recommended the treatment to others (median=5). Changes in FWHR varied among participants who requested a feminine appearance, except for one participant who sought a masculine appearance and whose FWHR increased.
CONCLUSION
Sensitivity, openness, and knowledge regarding the facial aspirations and treatment preferences of gender nonconforming patients can improve outcomes and increase patient satisfaction in this patient population.
PubMed: 38779375
DOI: No ID Found -
The Journal of Clinical and Aesthetic... May 2024Nose reshaping with hyaluronic acid (HA) fillers, also known as medical rhinoplasty, is an increasingly popular, minimally invasive aesthetic procedure. As the demand...
INTRODUCTION
Nose reshaping with hyaluronic acid (HA) fillers, also known as medical rhinoplasty, is an increasingly popular, minimally invasive aesthetic procedure. As the demand for nasal reshaping continues to rise, it is essential to develop safe and efficient injection techniques and assess satisfaction to ensure optimal outcomes and patient-centered care.
OBJECTIVE
This study aims to evaluate patient and physician satisfaction with hyaluronic acid filler applications using microinjection technique for nasal reshaping.
METHODS
The study included healthy adult patients who underwent medical rhinoplasty with the same HA filler using the microinjection technique. Patient satisfaction levels were evaluated at one and six months after the last injection using the Global Patient Satisfaction Scale (GPSS). Additionally, an independent dermatologist conducted a clinical evaluation for each patient by comparing before and after clinical pictures, using the Aesthetic Improvement Scale (AIS). Any side effects were recorded during each session and follow-up period for six months.
RESULTS
A total of 40 patients (37 women and 3 men) participated in the study. The most frequently targeted anatomical areas for filler injections were the nasal tip (100%), columella (100%), nasal prominence (100%), nasal dorsum (85%), and nasal root (82.5%). Injections distal to the nasolabial fold (NFL) were performed in 2.5 percent of patients. Patients expressed high satisfaction with the results at both one and six months after the procedure (mean GPSS, respectively; 4.65 and 4.47). Similarly, clinicians reported satisfaction with outcomes at the same time points (mean AIS, respectively; 1.7 and 1.4). Apart from mild pain during the procedure and transient erythema afterward, no side effects were recorded.
CONCLUSION
Medical rhinoplasty with HA fillers using the microinjection technique is an effective and reliable procedure. This technique provides safe and aesthetically pleasing results from both patient and dermatologist perspectives, making it a favorable option for nasal reshaping with HA dermal fillers.
PubMed: 38779374
DOI: No ID Found -
Archives of Dermatological Research May 2024Many individuals with vitiligo are uncertain about their skin cancer risk, phototherapy risks, and recommended sun protective practices. This study examined the...
Many individuals with vitiligo are uncertain about their skin cancer risk, phototherapy risks, and recommended sun protective practices. This study examined the perceived skin cancer risk and sun protective practices among individuals living with vitiligo. A secondary objective was to understand where participants obtain this information. This was a prospective cross-sectional study. An online survey was distributed to vitiligo support group leaders globally who shared the survey with their members. Individuals over the age of 18 and with vitiligo were included. There were 209 survey respondents, the majority were between the ages 35-54 (45.5%, n = 95), female (70.8%, n = 148), White (66.0%, n = 138). Nearly half of respondents believed they were at increased risk of skin cancer because of their vitiligo (45.5%, n = 95) and nearly a quarter (22.5%, n = 47) believed that phototherapy increased their risk of skin cancer. Having vitiligo affected sun protective practices with less than a quarter (24.4%, n = 51) of respondents using sunscreen daily or often prior to their vitiligo diagnosis in comparison to the majority of respondents (60.3%, n = 126) using it after their vitiligo diagnosis. The three most common sources where patients obtained information were the internet and social media (46.4%, n = 97), vitiligo support groups (23.4%, n = 49), and dermatologists (20.6%, n = 43). Despite evidence indicating a decreased risk of skin cancer in individuals with vitiligo and supporting the safety of narrowband ultraviolet B phototherapy, many participants believed they were at an increased risk of skin cancer. Findings were sub-stratified and showed differences in sunscreen usage based on gender, skin color, and percent depigmentation. This study also found nearly half of respondents obtained information related to vitiligo from the internet and social media. The number of participants may limit the generalizability of the findings. Survey questionnaires are also subject to response bias. The findings from this study highlight demographic variations in sunscreen usage which may help guide the development of targeted interventions to improve sun protective behaviors among diverse populations with vitiligo. In addition, this study suggests certain sun protective practices and skin cancer risk perceptions may vary based on extent of depigmentation. Lastly, this study also demonstrates the internet and social media as a popular source for obtaining information, emphasizing the need for dermatologists to leverage various online communication channels to help disseminate accurate information.
Topics: Humans; Vitiligo; Female; Cross-Sectional Studies; Male; Skin Neoplasms; Adult; Prospective Studies; Middle Aged; Sunscreening Agents; Health Knowledge, Attitudes, Practice; Surveys and Questionnaires; Young Adult; Aged; Sunburn; Risk Factors; Sunlight
PubMed: 38775848
DOI: 10.1007/s00403-024-02942-0 -
Scientific Reports May 2024Current assessment methods for diabetic foot ulcers (DFUs) lack objectivity and consistency, posing a significant risk to diabetes patients, including the potential for...
Current assessment methods for diabetic foot ulcers (DFUs) lack objectivity and consistency, posing a significant risk to diabetes patients, including the potential for amputations, highlighting the urgent need for improved diagnostic tools and care standards in the field. To address this issue, the objective of this study was to develop and evaluate the Smart Diabetic Foot Ulcer Scoring System, ScoreDFUNet, which incorporates artificial intelligence (AI) and image analysis techniques, aiming to enhance the precision and consistency of diabetic foot ulcer assessment. ScoreDFUNet demonstrates precise categorization of DFU images into "ulcer," "infection," "normal," and "gangrene" areas, achieving a noteworthy accuracy rate of 95.34% on the test set, with elevated levels of precision, recall, and F1 scores. Comparative evaluations with dermatologists affirm that our algorithm consistently surpasses the performance of junior and mid-level dermatologists, closely matching the assessments of senior dermatologists, and rigorous analyses including Bland-Altman plots and significance testing validate the robustness and reliability of our algorithm. This innovative AI system presents a valuable tool for healthcare professionals and can significantly improve the care standards in the field of diabetic foot ulcer assessment.
Topics: Diabetic Foot; Humans; Artificial Intelligence; Algorithms; Reproducibility of Results; Image Processing, Computer-Assisted; Severity of Illness Index
PubMed: 38773207
DOI: 10.1038/s41598-024-62076-1 -
Journal of Epidemiology and Global... May 2024Whether in the field of medical care, or in people's daily life and health protection, the importance of masks has been paid more and more attention. Acne, the most...
Whether in the field of medical care, or in people's daily life and health protection, the importance of masks has been paid more and more attention. Acne, the most common complication after wearing masks, which is also called maskne, has been successfully introduced into the common language as a common topic of dermatologist consultations. This study aims to study the changes of microflora in maskne patients and healthy controls before and after wearing masks. In the summer of 2023, we collected a total of 50 samples from 15 maskne patients and 10 healthy controls before and after wearing surgical masks for a long time. 16 S ribosomal DNA sequencing and identification technology with V3-V4 variable region were adopted to explore the microbiome changes caused by mask wearing, analyze the changes in microbial diversity, and make interaction network. LDA effect size analysis was used to identify which bacteria showed significant changes in their relative abundance from phylum to genus. After wearing a mask, the microbiome of the maskne patients changed significantly more than that of the healthy controls, with both α diversity and β diversity lower than those of maskne patients before wearing masks and those of healthy controls after wearing masks. Co-occurrence network analysis showed that compared with other groups, the network of maskne patients after wearing masks for a long time had the lowest connectivity and complexity, but the highest clustering property, while the opposite was true for healthy controls. Many microbes that are potentially beneficial to the skin decreased significantly after wearing a mask. There was almost no difference in healthy controls before and after wearing a mask.
PubMed: 38771488
DOI: 10.1007/s44197-024-00240-6 -
The Saudi Dental Journal May 2024PapillonLefèvre syndrome (PLS) is an autosomal recessive genetic disorder characterized by the presence of palmoplantar hyperkeratosis on the hands and feet, as well as... (Review)
Review
INTRODUCTION
PapillonLefèvre syndrome (PLS) is an autosomal recessive genetic disorder characterized by the presence of palmoplantar hyperkeratosis on the hands and feet, as well as severe periodontal disease affecting both the primary and permanent teeth, which can lead to premature tooth loss.
AIMS
This review aimed to characterize the etiology, clinical manifestations, diagnosis, and recent dental management strategies of pediatric patients with PLS.
MATERIAL AND METHODS
A comprehensive search of the electronic literature was conducted using specific keywords such as "PapillonLefèvre syndrome in dentistry," "Etiology of PapillonLefèvre syndrome," "Oral manifestations of PapillonLefèvre syndrome," "Management of PapillonLefèvre syndrome," and "Papillon-Lefèvre syndrome." A total of 47 publications that provided relevant information and discussed the various aspects of PLS were identified.
CONCLUSION
The management of PLS necessitates a multidisciplinary approach, including the active involvement of a dental surgeon, dermatologist, and pediatrician to ensure comprehensive care. Extraction of primary teeth and administration of antibiotics is a successful treatment strategy, while placement of removable partial denture is the best option for pediatric patients.
PubMed: 38766300
DOI: 10.1016/j.sdentj.2024.02.003