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Clinical Case Reports Jul 2024Noma is still around today and can be deadly if ignored. Prompt identification and comprehensive care are essential for averting permanent impairments and disfigurements.
KEY CLINICAL MESSAGE
Noma is still around today and can be deadly if ignored. Prompt identification and comprehensive care are essential for averting permanent impairments and disfigurements.
ABSTRACT
Noma is a rapid developing orofacial gangrene and a disabling disease that primarily affects young children who live in dangerous conditions. Underlying diseases such as HIV/AIDS and malnutrition can enhance the likelihood of Noma's emergence. This is a case of a 9-year-old girl patient who arrived malnourished and with an ulcerating communicating right mandibular soft tissue lesion as well as right hemiparesis which had an acute onset. The patient was likewise HIV positive discovered upon admission, possibly as a result of vertical transmission, and was an ART (antiretroviral therapy) treatment naive patient. A holistic treatment plan was installed and a positive clinical response was observed. Early treatment is key in Noma management.
PubMed: 38911917
DOI: 10.1002/ccr3.9111 -
Plastic and Reconstructive Surgery.... Jun 2024The maxilla comprises horizontal and vertical buttresses, each with specific functions, supporting various organs, such as the eyes, nose, and oral cavity. Notably, they...
BACKGROUND
The maxilla comprises horizontal and vertical buttresses, each with specific functions, supporting various organs, such as the eyes, nose, and oral cavity. Notably, they combine to form a three-dimensional structure, which enables the buttresses to provide their inherent support strength. However, reconstructing the maxilla after maxillectomy by assembling new buttresses is challenging. We successfully reconstructed all the buttresses crucial for facial appearance and dental rehabilitation using a vascularized fibular flap.
METHODS
Four patients underwent maxillary buttress reconstruction with a fibular flap after total or subtotal maxillectomy. We used computer-aided design/computer-aided manufacturing digital technology to osteotomize the fibula into multiple segments and assemble them to reconstruct the maxillary buttresses. Each buttress was assembled based on a preoperative simulation.
RESULTS
All patients underwent immediate one-stage maxillary reconstruction. They had good maxillary buttress alignment and acquired good facial appearance, eye position, nasal airway, and prosthetically suitable maxillary alveolus ridge.
CONCLUSIONS
The combination of computer-aided design/computer-aided manufacturing digital technology and surgical techniques has enabled novel maxillary reconstruction, providing great hope to patients experiencing facial disfigurement and loss of function after maxillectomy.
PubMed: 38911572
DOI: 10.1097/GOX.0000000000005914 -
Cell Communication and Signaling : CCS Jun 2024Excessive scar formation such as hypertrophic scars and keloids, resulting from trauma or surgical procedures, present a widespread concern for causing disfigurement,...
Excessive scar formation such as hypertrophic scars and keloids, resulting from trauma or surgical procedures, present a widespread concern for causing disfigurement, discomfort, and functional limitations. Macrophages play pivotal roles in maintaining tissue homeostasis, orchestrating tissue development, repair, and immune responses, and its transition of function and phenotype plays a critical role in regulating the balance between inflammation and tissue regeneration, which is central to cutaneous scar formation. Recent evidence suggests the involvement of Sonic Hedgehog (SHH) in the induction of anti-inflammatory M2-like macrophage phenotypes within tumor microenvironments. In our study, we observed increased SHH expression in human hypertrophic scars, prompting an investigation into its influence on macrophage polarization, efferocytosis, and cutaneous scar formation. Our findings reveal that SHH can enhance oxidative phosphorylation (OXPHOS) in macrophages, augment macrophage efferocytosis, and promote M2 polarization, finally contributing to the progression of cutaneous scar formation. Notably, targeting SHH signaling with vismodegib exhibited promising potential in mitigating scar formation by reversing the effects of enhanced OXPHOS and M2 polarization in macrophages. In conclusion, this study underscores the critical roles of macrophage metabolism, particularly OXPHOS, efferocytosis and SHH signaling in cutaneous scar formation. Understanding these mechanisms provides new avenues for potential interventions and scar prevention strategies.
Topics: Hedgehog Proteins; Macrophages; Humans; Oxidative Phosphorylation; Animals; Phagocytosis; Cicatrix, Hypertrophic; Mice; Signal Transduction; Cicatrix; Mice, Inbred C57BL; Anilides; Pyridines; Efferocytosis
PubMed: 38898530
DOI: 10.1186/s12964-024-01692-w -
Skin Research and Technology : Official... Jun 2024Hypertrophic scars (HS) are a common disfiguring condition in daily clinical encounters which brings a lot of anxieties and concerns to patients, but the treatment...
BACKGROUND
Hypertrophic scars (HS) are a common disfiguring condition in daily clinical encounters which brings a lot of anxieties and concerns to patients, but the treatment options of HS are limited. Black cloth ointment (BCO), as a cosmetic ointment applicable to facial scars, has shown promising therapeutic effects for facial scarring. However, the molecular mechanisms underlying its therapeutic effects remain unclear.
MATERIAL AND METHODS
Network pharmacology was first applied to analyze the major active components of BCO and the related signaling pathways. Subsequently, rabbit ear scar model was successfully established to determine the pharmacological effects of BCO and its active component β-elemene on HS. Finally, the molecular mechanism of BCO and β-elemene was analyzed by Western blot.
RESULTS
Through the network pharmacology, it showed that β-elemene was the main active ingredient of BCO, and it could significantly improve the pathological structure of HS and reduce collagen deposition. BCO and β-elemene could increase the expression of ER stress-related markers and promote the increase of apoptotic proteins in the Western blot experiment and induce the apoptosis of myofibroblasts.
CONCLUSIONS
Our findings indicate that the material basis for the scar-improving effects of the BCO is β-elemene, and cellular apoptosis is the key mechanism through which the BCO and β-elemene exert their effects.
Topics: Cicatrix, Hypertrophic; Rabbits; Animals; Ointments; Network Pharmacology; Disease Models, Animal; Sesquiterpenes; Humans; Apoptosis; Female; Male
PubMed: 38895902
DOI: 10.1111/srt.13791 -
Journal of Clinical Medicine Jun 2024Alopecia areata (AA) is a common form of non-scarring alopecia characterized by acute hair loss. Nail involvement, though not always present, can occur in AA patients.... (Review)
Review
Alopecia areata (AA) is a common form of non-scarring alopecia characterized by acute hair loss. Nail involvement, though not always present, can occur in AA patients. Nail changes are more frequent in severe forms of AA and in children. Literature related to nail changes in AA was comprehensively reviewed after a search on the PubMed database without time restrictions in order to identify common clinical presentations and associated factors to aid clinicians with the correct evaluation and management of these dystrophies. Nail changes in AA include pitting, trachyonychia, leukonychia, red lunula, and miscellaneous alterations such as longitudinal ridging and brittle nails. Nail changes are usually asymptomatic but, nevertheless, sometimes cosmetically disfiguring and can be associated with a reduced quality of life and impaired daily activities. Nail changes in AA may precede or follow hair loss and can occur as an isolated finding. Diagnosis may require a biopsy for definitive identification. Spontaneous improvement is possible, particularly in children, and treatment is not always necessary. Further research is, however, needed to establish a consensus on treatment approaches according to age and severity.
PubMed: 38893003
DOI: 10.3390/jcm13113292 -
International Journal of Molecular... May 2024Alopecia areata (AA) is an autoimmune-mediated disorder in which the proximal hair follicle (HF) attack results in non-scarring partial to total scalp or body hair loss.... (Review)
Review
Alopecia areata (AA) is an autoimmune-mediated disorder in which the proximal hair follicle (HF) attack results in non-scarring partial to total scalp or body hair loss. Despite the growing knowledge about AA, its exact cause still needs to be understood. However, immunity and genetic factors are affirmed to be critical in AA development. While the genome-wide association studies proved the innate and acquired immunity involvement, AA mouse models implicated the IFN-γ- and cytotoxic CD8+ T-cell-mediated immune response as the main drivers of disease pathogenesis. The AA hair loss is caused by T-cell-mediated inflammation in the HF area, disturbing its function and disrupting the hair growth cycle without destroying the follicle. Thus, the loss of HF immune privilege, autoimmune HF destruction mediated by cytotoxic mechanisms, and the upregulation of inflammatory pathways play a crucial role. AA is associated with concurrent systemic and autoimmune disorders such as atopic dermatitis, vitiligo, psoriasis, and thyroiditis. Likewise, the patient's quality of life (QoL) is significantly impaired by morphologic disfigurement caused by the illness. The patients experience a negative impact on psychological well-being and self-esteem and may be more likely to suffer from psychiatric comorbidities. This manuscript aims to present the latest knowledge on the pathogenesis of AA, which involves genetic, epigenetic, immunological, and environmental factors, with a particular emphasis on immunopathogenesis.
Topics: Alopecia Areata; Humans; Animals; Hair Follicle
PubMed: 38891839
DOI: 10.3390/ijms25115652 -
BMC Infectious Diseases Jun 2024Cutaneous Leishmaniasis (CL) is caused by protozoan parasite called Leishmania. It is endemic in more than 100 countries globally. Despite its vast prevalence and impact...
INTRODUCTION
Cutaneous Leishmaniasis (CL) is caused by protozoan parasite called Leishmania. It is endemic in more than 100 countries globally. Despite its vast prevalence and impact on quality of life, it is one of the most neglected tropical dermatological diseases. The CL burden has often been expressed based on the physical disfigurement caused by the disease. However, considering the impact of the disease beyond physical impairment and changes in patients' appearance would help to better understand the disease as a public health problem. The effect of CL on patients' quality of life was determined in this study.
METHODS
The data that were related to quality of life were collected using Standard one-week Dermatology Life Quality Index (DLQI) questionnaire. The questions were categorized under seven domains: symptoms & feelings, daily activities, work and school, leisure, personal relationships, and treatment. Each question was scored on a three-point scale: Very much (3), A lot (2), A little (1), Undecided (0), and Not at all (0). The sum of the scores lied between 0 and 48. A higher score shows worse quality of life. The data were entered and analysed using Statistical Package for Social Science 23. Frequencies and proportions were used to describe the data. Differences were considered statistically significant at p < 0.05.
RESULTS
The lives of the majority of CL patients (60.7%) were significantly affected by CL. The quality of life of patients was moderately impacted by CL in 25% of the CL patients. In 32.1% of the CL patients, the effect of CL on patients' quality of life was very large. The quality of one CL patient's life was extremely largely affected. The disease had a small effect on 32.1% of the CL patients. Personal relationship was the most affected domain followed by symptoms and feelings and treatment. Future study including rural regions is required.
CONCLUSION
The Dermatology Life Quality Index demonstrates that CL has a small to extremely very large negative effect on the quality of life of patients.
Topics: Humans; Quality of Life; Leishmaniasis, Cutaneous; Male; Female; Adult; Middle Aged; Surveys and Questionnaires; Young Adult; Adolescent; Aged; Child
PubMed: 38890616
DOI: 10.1186/s12879-024-09518-3 -
EJVES Vascular Forum 2024Aneurysmorrhaphy, described as reduction aneurysmoplasty, partial aneurysmectomy, or vessel wall recalibration, can be considered a suitable surgical plan for true...
Salvage Aneurysmorrhaphy as an Adaptable and Still Pertinent Technique in the Management of Challenging True Aneurysms of Arteriovenous Fistulas: A Case Series of Different Variations, With Illustrative Surgical Pictures.
INTRODUCTION
Aneurysmorrhaphy, described as reduction aneurysmoplasty, partial aneurysmectomy, or vessel wall recalibration, can be considered a suitable surgical plan for true aneurysms of arteriovenous fistulas (AVFs), allowing for a dynamic approach to reconstruction of aneurysmal AVFs of different severities, ensuring salvage of the native access.
REPORT
Six challenging cases of AVF aneurysms are presented, some with extremely dilated and tortuous megafistulas, for which three surgical technique variations were performed. The patients had a mean age of 59.2 years, 50% were female, with brachiocephalic ( = 5, 83.3%) or brachiobasilic ( = 1, 16.7%) AVFs. The fistulas were created an average of 4.67 years previously, and the aneurysms had an average maximum diameter of 37.5 mm (range 25-60 mm). Surgical indications were rupture risk, thrombosis, or outflow stenosis compromising haemodialysis, infections, and concerns for quality of life (affected by post-puncture bleedings, disfiguring aesthetics, pain, and discomfort). The surgical techniques were simple aneurysmorrhaphy ( = 3, 50%), aneurysmorrhaphy with partial excision of aneurysmal segment with end to end anastomosis of venous ends ( = 2, 33.3%), and aneurysmorrhaphy with establishment of new venous outflow ( = 1, 16.7%). All AVFs were patent post-operatively and at follow up (mean 5.6 months, median one month). Haemodialysis was resumed through the AVFs at a mean of 2.17 weeks post-operatively, with placement of an alternative route for haemodialysis in the meantime. No patients experienced post-operative complications.
DISCUSSION
Experience with the more challenging cases shows that aneurysmorrhaphy can still be considered an acceptable, flexible, and pertinent method for salvage of megafistulas, giving the surgeon the much needed versatility to adapt to anatomical and pathological variations, with high patency rates and minimal complications, especially when other treatment options are not possible in complicated cases. AVF salvage through aneurysmorrhaphy allows for a dynamic approach to the reconstruction of severely tortuous, dilated veins, ensuring patency of the native AVF.
PubMed: 38884071
DOI: 10.1016/j.ejvsvf.2024.05.002 -
Journal of Pharmacy & Bioallied Sciences Apr 2024Cancers affecting the parts of the head and neck significantly impact patients. Among head and neck cancer (HNC) patients, the visible signs and symptoms of the disease...
INTRODUCTION
Cancers affecting the parts of the head and neck significantly impact patients. Among head and neck cancer (HNC) patients, the visible signs and symptoms of the disease or the side effects of treatment modalities can cause various degrees of functional impairment such as mastication, swallowing, communication, and disfigurement.
OBJECTIVE
To assess psychological distress and quality of life in head and neck cancer patients after 3 and 6 months' post-treatment.
MATERIALS AND METHODS
A hospital-based follow-up study was conducted among head and neck cancer patients who came for routine follow-up after treatment in five cancer hospitals in Hyderabad City. Patients were categorized based on the treatment into surgery, chemotherapy, radiotherapy, and combination of all and the same subjects were followed; after 3 months, psychological distress and quality of life were assessed by distress thermometer and functional assessment of cancer therapy head and neck (FACT H and N).
RESULTS
A total of 235 participants were included in the study. Mean age was 58.2 ± 8.7 years. The mean scores of psychological distress at baseline were 4.6 ± 1.2, and after follow-up, it was 3.4 ± 1.2 and the mean scores of quality of life at baseline were 76.4 ± 15.6, and after follow-up, it was 75.5 ± 12.5.
CONCLUSION
The mean scores of psychological distress had reduced from baseline to follow-up with negligible improvement in the quality of life.
PubMed: 38882774
DOI: 10.4103/jpbs.jpbs_1039_23 -
International Journal of Surgery Case... Jul 2024The use of radiation therapy for infantile hemangiomas 30 years ago has led to severe consequences in adulthood.
INTRODUCTION AND IMPORTANCE
The use of radiation therapy for infantile hemangiomas 30 years ago has led to severe consequences in adulthood.
CASE PRESENTATION
This article shares the experience of using multiple reconstructive procedures to treat radiation-induced hemifacial sequelae for capillary malformations. Based on the damaged anatomical surgical units, appropriate reconstructive materials are used for the surgery. Thin antero-lateral thigh (ALT) flaps cover lesions on the forehead and cheeks, while a skin expander covers the temporal scalp lesion. Autologous grafting covers damage in both eyelids.
CLINICAL DISCUSSION
Choosing a suitable reconstructive material will provide aesthetic outcomes such as facial symmetry, skin color compatibility, and textural similarity in the constructive areas for the patient. The patients were highly satisfied with the surgical results.
CONCLUSION
Using appropriate surgical techniques and materials, along with meticulous attention to facial integrity, can achieve optimal aesthetic and functional outcomes in patients with severe facial disfigurement from radiation therapy. A thorough understanding of pathophysiology and anatomy, along with skillful execution, can result in a successful outcome and improved quality of life.
PubMed: 38880001
DOI: 10.1016/j.ijscr.2024.109906