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Dermatology Practical & Conceptual Apr 2024Self-induced dermatoses are self-inflicted skin lesions, whose occurrence patient denies responsibility for.
INTRODUCTION
Self-induced dermatoses are self-inflicted skin lesions, whose occurrence patient denies responsibility for.
OBJECTIVES
The aim of this study was to retrospectively investigate all the clinical records of dermatitis artefacta (DA) in order to put special focus on: a) epidemiological aspects; b) location, shape and additional features of the lesions; c) availability of psychiatric details in the records.
METHODS
A retrospective observational descriptive study on 46 patients affected by dermatitis artefacta was conducted from January 2015 to March 2021. The only inclusion criterion was clinical or histological diagnosis of DA in patients for which we had clinical images.
RESULTS
The most frequent type of lesions were erosions/excoriations and ulcers (14/46, 30.4% and 13/46, 28.3% respectively) followed by ecchymoses (9/46, 19.5%), vasculitis-like lesions (5/46, 10.9%), crusted plaques (3/46, 6.5%), scales (1/46, 2.2%) and erythema (1/46, 2.2%). Thirty-three percent of the medical records generically referred to the presence of psychiatric disorder, but none of them included a specific psychiatric diagnosis.
CONCLUSIONS
In our study the main dermatologic lesions observed in DA were represented by excoriations and ulcers and that the shape and location of the lesions are essential for a correct diagnosis.
PubMed: 38810059
DOI: 10.5826/dpc.1402a53 -
World Journal of Clinical Cases May 2024Breast conservation surgery (BCS) with adjuvant radiotherapy has become a gold standard in the treatment of early-stage breast cancer, significantly reducing the risk of...
BACKGROUND
Breast conservation surgery (BCS) with adjuvant radiotherapy has become a gold standard in the treatment of early-stage breast cancer, significantly reducing the risk of tumor recurrence. However, this treatment is associated with adverse effects, including the rare but aggressive radiation-induced angiosarcoma (RIAS). Despite its rarity and nonspecific initial presentation, RIAS presents a challenging diagnosis, emphasizing the importance of imaging techniques for early detection and accurate diagnosis.
CASE SUMMARY
We present a case of a 48-year-old post-menopausal woman who developed skin ecchymosis on the right breast seven years after receiving BCS and adjuvant radiotherapy for breast cancer. Initial mammography and ultrasound were inconclusive, showing post-treatment changes but failing to identify the underlying angiosarcoma. Contrast-enhanced breast magnetic resonance imaging (MRI) revealed diffuse skin thickening and nodularity with distinctive enhancement kinetics, leading to the diagnosis of RIAS. This case highlights the crucial role of MRI in diagnosing and determining the extent of RIAS, facilitating timely and appropriate surgical intervention.
CONCLUSION
Breast MRI is crucial for detecting RIAS, especially when mammography and ultrasound are inconclusive.
PubMed: 38808350
DOI: 10.12998/wjcc.v12.i13.2237 -
BMC Health Services Research May 2024Disease registries are comprehensive databases that record detailed information on patients diagnosed with specific conditions, providing valuable insights into their...
BACKGROUND
Disease registries are comprehensive databases that record detailed information on patients diagnosed with specific conditions, providing valuable insights into their diagnosis, treatment, and outcomes. This study aims to describe the pilot phase of the national pediatric Immune Thrombocytopenia(ITP) registry (NPITP) in Iran, serving as the inaugural interpretive report.
METHODS
This patient-centered software system was implemented as a national program across multiple pediatric centers in Iran. Several focus groups were conducted to establish a minimum data set (MDS) comprising six main classes, 14 sub-classes, and 187 data elements. Following expert consensus on the final data set, a web-based software tool was developed by the dedicated IT team, accessible online and offline via https://disreg.sbmu.ac.ir/q/ITP.html . The registry included children aged between two months and 18 years with a platelet count below 100 × 10/L, based on predefined inclusion criteria.
RESULTS
Within a four-month period, a total of 60 ITP patients were registered, including 41 (68.3%) newly diagnosed cases, 68 (13.6%) persistent cases, and 14 (23.3%) with chronic ITP. The mean age of the registered patients was 55.93 ± 9.72 months. The most frequently observed bleeding symptoms were petechiae (68.3%), purpura (51.6%), and ecchymosis (13.3%). Among the newly diagnosed patients, 20 (33.3%) received intravenous immunoglobulin (IVIG), 17 (28.3%) were treated with prednisolone, and 17 (28.3%) received combined IVIG and steroid therapy. Of all patients, 40 (66.7%) demonstrated a complete response to treatment, while 16 (26.7%) exhibited a partial response. Four patients (6.7%) remained unresponsive to therapy. Treatment-related complications, such as Cushing's syndrome, edema, weight gain, hirsutism, and mood disorders, were reported in 10 patients (16.6%). However, the majority of patients (81.7%) did not experience therapy-related complications.
CONCLUSION
The pilot phase of the NPITP registry successfully implemented a web-based software tool for data collection, aiming to enhance the quality of care, facilitate clinical research, and support health service planning in the future.
Topics: Humans; Registries; Child; Iran; Purpura, Thrombocytopenic, Idiopathic; Child, Preschool; Adolescent; Male; Female; Infant; Pilot Projects
PubMed: 38807135
DOI: 10.1186/s12913-024-11102-z -
Medicine May 2024Acquired hemophilia-A (AHA) is a rare but potentially life-threatening impaired coagulation disorder characterized by the development of autoantibodies against clotting...
INTRODUCTION
Acquired hemophilia-A (AHA) is a rare but potentially life-threatening impaired coagulation disorder characterized by the development of autoantibodies against clotting factor VIII. Only a few case reports have been experienced with influenza vaccine-triggered AHA. Here, we report a case of severe hemorrhagic disorder due to AHA following influenza vaccine, which was successfully treated.
PATIENT CONCERNS
The patient presented to the emergency department because of several severe, progressively worsening bruises after receiving the influenza vaccination. Consequently, the patient required intubation due to nasal-oral bleeding, which compromised the airway, and retroperitoneal hemorrhage with shock also developed.
DIAGNOSIS
AHA was confirmed through a coagulation factor assay, including coagulation activity and antibody testing, which is possibly triggered by influenza vaccination.
INTERVENTION
Low-dose cyclophosphamide and hydrocortisone were prescribed until activated partial thromboplastin time showed normal levels. Coagulation factor VIIa was administered, and aggressive blood transfusion was carried out concurrently to address the blood loss.
OUTCOMES
The upper airway bleeding subsided and bleeding tendencies had been corrected to normal. The patient was smoothly weaned from the ventilator and recovered from critical illness. She was then discharged on the 19th day.
LESSONS
The activated partial thromboplastin time mixing test can be performed immediately to establish the initial differential diagnosis and treatment plan for severe coagulopathy. AHA may be triggered by vaccination, with the hypothesis of activation of autoantibodies and molecular mimicry; this mechanism should be further studied.
Topics: Humans; Hemophilia A; Female; Ecchymosis; Hemorrhage; Retroperitoneal Space; Influenza Vaccines; Middle Aged
PubMed: 38787989
DOI: 10.1097/MD.0000000000038300 -
Cureus Apr 2024Background During the COVID-19 pandemic, Americans transitioned away from their normal routines, drove in motor vehicles less, and reduced their physical activity,...
Background During the COVID-19 pandemic, Americans transitioned away from their normal routines, drove in motor vehicles less, and reduced their physical activity, ultimately influencing the incidence and nature of orthopedic injuries that were operatively managed. The purpose of this study was to evaluate the effect of the COVID-19 pandemic lockdown and subsequent deconditioning on the mechanism of injury and severity of Lisfranc injury. Methods This retrospective study included patients with a traumatic Lisfranc injury who were surgically treated by a foot and ankle fellowship-trained orthopedic surgeon between 2015 and 2021. Electronic health records were queried for patient demographics, mechanism of injury, physical exam findings, and pain scores. Preoperative radiographs were reviewed to grade Lisfranc injuries using the previously described Nunley-Vertullo classification system. Descriptive and univariate statistics were performed to compare 15 patients in the pre-COVID-19 cohort and 15 patients in the post-COVID-19 cohort. Results In the pre-COVID-19 cohort, 80% (n=12/15) of the patients were female, the mean age was 46±15 years, the mean BMI was 29.7±7 kg/m, and the mean follow-up period was 18.1±12 months. In the post-COVID-19 cohort, 53% (n=8/15) of the patients were female, the mean age was 48.5±17 years, the mean BMI was 31.4±7 kg/m, and the mean follow-up period was 9.5±4 months. Significantly higher proportions of plantar ecchymosis (n=8/15, 53%), neuropathic pain (n=7/15, 47%), and swelling (n=12/15, 80%) were present in the post-COVID-19 cohort. A low-energy mechanism of injury was sustained by 73% (n=11/15) of the pre-COVID-19 cohort and 80% (n=12/15) of the post-COVID-19 cohort. Lisfranc injuries for the pre-COVID-19 cohort and the post-COVID-19 cohort demonstrated the following classifications: Grade 1 (33%, n=5/15 vs. 40%, n=6/15), Grade 2 (60%, n=9/15 vs. 53%, n=8/15), and Grade 3 (7%, n=1/15 vs. 7%, n=1/15). Conclusion Although a higher proportion of plantar ecchymosis, neuropathic pain, and swelling was observed, there was no association between a low mechanism of injury and a higher grade of Lisfranc injury following the COVID-19 pandemic.
PubMed: 38770506
DOI: 10.7759/cureus.58644 -
Clinical Case Reports May 2024In a patient with de novo AML, co-existing isoform and rearrangement is accompanied by a very poor prognosis including limited response to treatment and no molecular...
KEY CLINICAL MESSAGE
In a patient with de novo AML, co-existing isoform and rearrangement is accompanied by a very poor prognosis including limited response to treatment and no molecular remission. It is essential to develop a consensus on the therapeutic modalities different from the current regimen.
ABSTRACT
Acquisition of fusion as a primary or secondary event and fusion independently is reported in de novo and therapy-related MDS/AML, albeit with low frequency (<0.5%). Coexistence of and translocation is known to cause leukemogenesis in animal models and progression towards blast crisis CML but not AML. Here we report a unique case of pediatric AML with concomitant BCR::ABL1 and RUNX1::MECOM fusion.Routine diagnostic work-up included WBC manual differential, immunophenotype, morphology, qPCR, FISH, and NGS-based CNV analyses. The patient presented with history of fever, dizziness, fatigue, gingival bleeding, and epistaxis associated with ecchymosis in right hand and heavy, prolonged menstrual period. At presentation, her hemoglobin was 5.3 g/dL, WBC 52.1(10*9/L), PLT 10(10*9/L), ESR 5 mm/h and LDH 2658 U/L. Bone marrow was hypercellular with 71% blasts, and flow cytometry showed myeloid markers including CD11c, CD33, CD34, and CD45 among others indicating AML with monocytic differentiation. FISH analyses showed variant t(9;22) (q34.1;q11.1), one additional copy each of chromosome 8 and gene, while NGS-based CNV analyses revealed a terminal and proximal pathogenic gain within 9q34.12q34.3 and 22q11.1q11.23, respectively, and gain of entire chromosome 8 and 12 in mosaic state. qPCR confirmed the presence of and also revealed fusion. Patient received ADE (cytarabine, daunorubicin, and etoposide) induction regimen but required multiple ICU admissions due to sepsis, cardiac shock, acute myocarditis, and thyroiditis. Coexisting and fusion is suggestive of poor prognosis, and a need for consensus on the treatment modalities other than the current regimen is warranted.
PubMed: 38751957
DOI: 10.1002/ccr3.8917 -
PloS One 2024Episiotomy is associated with side effects, such as pain and wound infection. Additionally, discomfort after episiotomy affects the quality of life of both the mother... (Randomized Controlled Trial)
Randomized Controlled Trial
Randomized controlled trial of the effectiveness of olive and black seed oil combination on pain intensity and episiotomy wound healing in primiparous women: A study protocol.
BACKGROUND
Episiotomy is associated with side effects, such as pain and wound infection. Additionally, discomfort after episiotomy affects the quality of life of both the mother and the baby. Medicinal herbs are one alternative method for the treatment of episiotomy wounds. This study will investigate the effectiveness of the combination of olive and black seed oil on pain intensity and the healing of episiotomy wounds in primiparous women.
METHODS
This randomized clinical trial will be conducted on primiparous women who have had a normal delivery with an episiotomy. There are 3 groups in this study: one group will receive a combination of olive oil and black seed oil, another group will receive olive oil alone, and the use of oils will start 24 hours after delivery. Ten drops will be applied topically 3 times a day for 10 days. The third group (control) will receive only routine care. Data will be collected through a demographic characteristics questionnaire, REEDA (Redness, Edema, Ecchymosis, Discharge, and Approximation) Scale, and Visual Analog Scale. To determine and compare the effects of pharmaceutical interventions on pain intensity and episiotomy wound healing in the groups, an analysis of variance (ANOVA) test with repeated measurements will be used with SPSS version 22.
DISCUSSION
The results of this study will show the effects of a combination of olive and black seed oil, as well as olive oil alone, on pain intensity and episiotomy wound healing in primiparous women. The positive effects observed in this trial with these oils could be valuable for women who have undergone an episiotomy.
Topics: Humans; Female; Episiotomy; Olive Oil; Wound Healing; Plant Oils; Adult; Pregnancy; Pain Measurement; Parity; Young Adult
PubMed: 38748938
DOI: 10.1371/journal.pone.0302161 -
International Journal of Nursing... Dec 2023Perineal tears in vaginal birth are highly prevalent and may be related to physical and psychological trauma. Surgical glues are an alternative repair method to avoid...
BACKGROUND
Perineal tears in vaginal birth are highly prevalent and may be related to physical and psychological trauma. Surgical glues are an alternative repair method to avoid the pain that may be caused by perineal repairs with sutures.
OBJECTIVE
To evaluate the effectiveness of surgical adhesive glue in reducing perineal pain when compared to sutures in first-degree perineal tears resulting from vaginal birth.
DESIGN
Open-label parallel-group randomised controlled trial.
SETTING
An alongside birth centre in Sao Paulo, Brazil.
PARTICIPANTS
84 intrapartum women with first-degree perineal tears needing repair.
METHODS
In the experimental group ( = 42), the perineal tears were repaired with Epiglu® surgical glue (ethyl-2-cyanoacrylate); in the control group ( = 42), the tears were repaired with Vicryl Rapide® (polyglactin 910) sutures. The primary outcome was the intensity of perineal pain after birth measured by a numeric pain rating scale ranging from 0 to 10 points. The secondary outcomes were healing, measured by the "Redness, Oedema, Ecchymosis, Discharge, and Approximation" scale; women's satisfaction with the perineal repair, measured by a visual analogue scale; and the time necessary to complete the repair. Data were collected during postpartum hospitalisation and 10-20 days after discharge, from December 2020 to May 2021. Data were analysed using bivariate analysis and linear models by intention-to-treat.
RESULTS
36-48 h after birth, the mean of perineal pain was 0.2 (95% Confidence Interval [CI] 0.1-0.8) in the experimental group and 0.9 (95% CI 0.5-1.5) in the control group; the perineal healing score was 0.7 (95% CI 0.4-1.2) and 0.8 (95% CI 0.5-1.2), in the experimental and control groups, respectively; satisfaction was higher among women in the experimental group (88.1% versus 83.3% in the control group). After discharge, the mean of perineal pain was 0.1 (95% CI 0.0-0.5) in the experimental group and 1.4 (95% CI 0.8-2.2) in the control group; the perineal healing score was 0.0 (95% CI 0) and 1.0 (95% CI 0.7-1.3) in the experimental and control groups, respectively. Satisfaction was higher in the experimental group (94.9% versus 75.0%). The longitudinal analysis showed statistically significant differences between the groups regarding perineal pain and women's satisfaction. The average time necessary for perineal repair was 6.0 (95% CI 4.7-8.7) minutes in the experimental group and 9.7 (95% CI 8.3-11.5) in the control group ( < 0.001).
CONCLUSIONS
Surgical glue resulted in less perineal pain, faster repair, and greater satisfaction than perineal sutures after birth. The healing process was similar in both cases.
TWEETABLE ABSTRACT
Surgical glue was less painful and promoted greater satisfaction after birth compared to sutures in women with first-degree perineal tears.
REGISTRATION
Registered on The Brazilian Clinical Trials Registry number RBR-52y5tq (http://www.ensaiosclinicos.gov.br/rg/RBR-52y5tq/), on July 16, 2020. The first recruitment was on December 17, 2020.
PubMed: 38746582
DOI: 10.1016/j.ijnsa.2023.100130 -
Journal of Infection in Developing... Apr 2024Streptococcus suis (S. suis) disease is a zoonotic infection caused by invasive S. suis and can lead to meningitis, septic shock, arthritis, and endocarditis. Early...
INTRODUCTION
Streptococcus suis (S. suis) disease is a zoonotic infection caused by invasive S. suis and can lead to meningitis, septic shock, arthritis, and endocarditis. Early treatment is the key to reducing mortality. However, clinical manifestations of most cases are atypical, severely limiting rapid diagnosis and treatment.
CASE REPORT
Here, we report a 74-year-old female patient diagnosed with S. suis infection. The main symptoms were hearing loss, lumbago, and scattered ecchymosis of the lower extremities and trunk. Blood non-specific infection indexes were significantly increased and platelets were significantly decreased; however, no pathogens were obtained from routine blood culture. Finally, the S. suis infection was confirmed by metagenomic next-generation sequencing (mNGS) of blood and cerebrospinal fluid. After antibiotic treatment, the limb and trunk scattered ecchymosis and lumbago symptoms were significantly relieved, but the hearing did not recover.
CONCLUSIONS
Human infection with S. suis is rare in central cities, and it is easy to misdiagnose, especially in cases with atypical early symptoms. mNGS technology, combined with clinical observation, is helpful to clarify the direction of diagnosis and treatment, which is conducive to patient recovery.
Topics: Humans; Streptococcus suis; Female; Aged; Streptococcal Infections; High-Throughput Nucleotide Sequencing; Metagenomics; Anti-Bacterial Agents
PubMed: 38728637
DOI: 10.3855/jidc.18805 -
WMJ : Official Publication of the State... May 2024Acute myelomonocytic leukemia is a type of acute myeloid leukemia with monocytic expansion. Both the disease and its treatment can be immunocompromising....
INTRODUCTION
Acute myelomonocytic leukemia is a type of acute myeloid leukemia with monocytic expansion. Both the disease and its treatment can be immunocompromising. Immunocompromised patients are more susceptible to infections, such as Fournier's gangrene, a rare necrotizing infection of the groin.
CASE PRESENTATION
A 56-year-old male presented to the emergency department with abdominal pain, leukocytosis, and perineal ecchymosis. Overnight, his perineal discoloration and tenderness worsened. He underwent irrigation and debridement for Fournier's gangrene and received broad-spectrum antimicrobial therapy. Subsequent workup revealed acute myeloid leukemia with leukemia cutis and central nervous system involvement, necessitating chemotherapy initiation prior to complete wound healing.
DISCUSSION/CONCLUSIONS
This case highlights the challenges in the diagnosis and management of acute leukemia in the setting of a concomitant life-threatening soft tissue infection, as both the hematologic disease and treatment thereof can exacerbate infectious complications.
Topics: Humans; Fournier Gangrene; Male; Middle Aged; Leukemia, Myelomonocytic, Acute; Diagnosis, Differential; Debridement; Immunocompromised Host
PubMed: 38718243
DOI: No ID Found