Body Surface Research Articles

Atrial remodelling associated with sporting discipline, sex and duration in elite sports: a cross-sectional echocardiographic study among Danish elite athletes

BackgroundElite endurance training is characterised by a high-volume load of the heart and has been associated with atrial fibrillation (AF) in middle-aged men. We compared left atrial (LA) remodelling among...

Linear growth in children and adolescents with congenital adrenal hyperplasia.

Congenital adrenal hyperplasia (CAH) is a relatively common disorder and one of the most challenging conditions seen by pediatric endocrinologists. Poor linear growth in CAH has been recognized for many years. There are new insights to explain this abnormality and shed light on strategies to promote normal growth. Published data suggest that the dose of hydrocortisone during two critical periods of rapid growth, namely infancy and at puberty, has a fundamental effect on growth velocity, and by definition adult height. To prevent over-treatment, hydrocortisone dosage should remain within the range of 10-15 mg/m2 body surface area per day. Precursor steroids such as 17-hydroxy progesterone (17OHP) should not be suppressed to undetectable levels. In fact, 17OHP should always be measurable, as complete suppression suggests over-treatment. CAH is a challenging disorder. High-quality compliance within the consultation setting, with the patient seeing the same specialist at every visit, will be rewarded by improved long-term growth potential. Quality auxological monitoring can avoid phases of growth suppression. New therapy with CRH receptor antagonists may lead to a more nuanced approach by allowing fine tuning of hydrocortisone replacement without the need to suppress ACTH secretion.

Clinical and pathogenetic assessment of cyclosporine efficacy in the complex therapy of non-segmental vitiligo patients

BACKGROUND: Vitiligo is a chronic disease of unknown etiology, characterized by the appearance of depigmented spots on various areas of the skin, rarely on mucous membranes, and discolored hair due to destruction and reduction of melanocytes. While not life-threatening, vitiligo significantly impacts the psychoemotional aspect. Studies assessing the quality of life of vitiligo patients reveal the presence of depression in these individuals. In addition to depression, a high susceptibility to anxiety, stigmatization, sleep disturbances, adaptation, and problems in personal relationships have been identified. The prevalence of depression and anxiety among vitiligo patients is comparable to other dermatological conditions such as atopic dermatitis, acne, psoriasis, and urticaria. This underscores the need to seek new means and methods for treating this condition. AIM: Clinical assessment of the effectiveness of using cyclosporine in combination with UVB 311 nm and monotherapy with UVB 311 nm for vitiligo. MATERIALS AND METHODS: The study involved 40 patients with progressive vitiligo. All patients were randomly divided into two groups. Group 1 (20 individuals) underwent a course of cyclosporine therapy in combination with UVB therapy, while Group 2 (20 individuals) received monotherapy with UVB 311 nm. The duration of the treatment was 6 months. The extent of the affected area relative to the body surface area was evaluated using the VES index (Vitiligo extent score) on a vitiligo calculator. The impact of the disease on the quality of life was assessed using the VitiQoL scale (vitiligo-specific quality-of-life instrument). RESULTS: All patients included in the study completed the full course of treatment. Group 1 (20 individuals) underwent a course of cyclosporine therapy in combination with UVB therapy, while Group 2 (20 individuals) received monotherapy with UVB 311 nm. Patients in the combined therapy group experienced earlier stabilization of the skin process compared to those receiving monotherapy with UVB 311 nm. Additionally, Group 1 demonstrated more pronounced repigmentation of vitiligo lesions and significant improvement in quality of life compared to Group 2. CONCLUSION: Cyclosporine in combination with narrowband phototherapy at 311 nm demonstrated good clinical efficacy and significant improvement in quality of life for non-segmental vitiligo patients. Cyclosporine is well-tolerated, has a low spectrum of side effects, and can be used long-term for patients with active vitiligo.

A non-invasive method to determine core temperature for cats and dogs using surface temperatures based on machine learning

BackgroundRectal temperature (RT) is an important index of core temperature, which has guiding significance for the diagnosis and treatment of pet diseases.ObjectivesDevelopment and evaluation of an alternative method based on machine learning to determine the core temperatures of cats and dogs using surface temperatures.Animals200 cats and 200 dogs treated between March 2022 and May 2022.MethodsA group of cats and dogs were included in this study. The core temperatures and surface body temperatures were measured. Multiple machine learning methods were trained using a cross-validation approach and evaluated in one retrospective testing set and one prospective testing set.ResultsThe machine learning models could achieve promising performance in predicting the core temperatures of cats and dogs using surface temperatures. The root mean square errors (RMSE) were 0.25 and 0.15 for cats and dogs in the retrospective testing set, and 0.15 and 0.14 in the prospective testing set.ConclusionThe machine learning model could accurately predict core temperatures for companion animals of cats and dogs using easily obtained body surface temperatures.

The use of a thoracodorsal flap in the surgical treatment of squamous cell skin cancer (case report)

We report a case of successful surgical treatment of a patient with locally advanced cutaneous squamous cell cancer (cSCC) originating from a burn scar. The burn scar cSCC tends to be more aggressive in nature than conventional skin SCC. treatment of patients with cSCC arising from a burn scar is complicated by the fact that the extensive defects formed after tumor removal are almost impossible to close with local tissues. Purpose: to demonstrate the feasibility of performing surgery for locally advanced cSCC using a thoracodorsal flap. Clinical case description. A 70-year old man presented with cSCC of the right shoulder. The patient had experienced a severe burn covering 70 % of his body surface area at a young age. To repair a large skin defect after tumor resection in the right shoulder, a thoracodorsal artery perforator flap was used. there were no complications in the postoperative period. At a follow-up of 7 months, no evidence of tumor recurrence was observed. Conclusion. The thoracodorsal artery perforator flap has contributed to the efficient reconstruction of extensive soft tissue defects in patients with locally advanced cSCC originating from a burn scar.

Rapid and sustained improvement of psoriasis with Bimekizumab: A real‐world case series

AbstractThis retrospective case series examines the efficacy and safety of Bimekizumab in 22 patients with moderate to severe plaque psoriasis in a real‐world clinical setting. The demographic and clinical characteristics of the participants, including a mean age of 43.7 years and a gender distribution of 60% male and 40% female, are summarised. Notably, 70% of the patients had previously received systemic therapy, and 50% had concurrent psoriatic arthritis. The evaluation over a 12‐week treatment period revealed a significant reduction in psoriasis area and severity index scores from a baseline mean of 11.5−1.0 at Week 4 and further down to 0.3 by Week 12. Similar improvements were observed in body surface area, physician's global assessment and dermatology life quality index scores. Bimekizumab was well‐tolerated with no reported adverse events, leading to no treatment discontinuations. These findings highlight the potential of Bimekizumab to provide rapid and sustained improvements in patients with moderate to severe plaque psoriasis, underlining its value in clinical practice.

Alteration in the Raman spectra of characteristic rock‐forming silicate mixtures due to micrometeorite bombardment

AbstractInnovative techniques are required for the in situ investigation of the surfaces of planetary bodies when landings are planned. Raman spectroscopy turned out as an excellent tool for fast mineralogical analyses on space missions. Contribution from a photoluminescence signal is not unexpected and is likely to be even more pronounced on celestial surfaces with a dilute or absent atmosphere exposed to strong space weathering, for example, micrometeorite bombardment. Such signals were found, for example, in Raman analysis of the probes from sample‐return missions. While photoluminescence is generally considered as an accompanying undesired product in the Raman spectral measurement, our studies show that some analytical information can be derived from this signal, and even more, due to the specific correlation of luminescence intensity with space weathering products. Therefore, we investigate the Raman spectra alteration of characteristic rock‐forming mineral mixtures (olivine, pyroxene and plagioclase) by micrometeorite bombardment, which is simulated by nanosecond‐pulse laser irradiation. The changes in the minerals are strongly dependent on the composition and structure. They range from disappearing changes in the minerals with simple chemistry and structure to complete amorphization of minerals with relatively low melting enthalpy. With Raman spectroscopy, we found out that the photoluminescence signals show resonant or anti‐resonant changes to specific mineral phases and amorphization. Furthermore, ablation‐induced iron nanoparticles of minerals containing Fe are detectable by Raman spectroscopy due to their alteration into iron oxides. Trapped volatiles in the matrices are analysed due to the formation of the compounds containing them. This broad spectrum of results indicating specific change phenomena due to space weathering can be effectively used for in situ Raman analysis in planetary missions.

First time surgical aortic valve replacement: nationwide trends and outcomes from The Netherlands heart registration.

To describe trends and outcomes for patients undergoing surgical aortic valve replacement in the Netherlands. The Netherlands Heart Registration database was used to report the number and outcomes of isolated, primary surgical aortic valve replacement procedures performed from 2007 to 2018 in adult patients. A total of 17142 procedures were included, of which 77.9% were performed using a biological prosthesis and 21.0% with a mechanical prosthesis. Median logistic EUROSCORE I decreased from 4.6 (IQR 2.4-7.7) to 4.0 (IQR 2.6-6.0). 120-day mortality decreased from 3.3% in 2007 to 0.7% in 2018. Median duration of follow-up was 76 months (IQR 53-111). Ten-year survival, when adjusted for age, EUROSCORE I, and body surface area, was 72.4%, and adjusted 10-year freedom from reinvervention was98.1%. Additional analysis for patients under the age of 60 showed no difference between patients treated with a biological or mechanical prosthesis in adjusted 10-year survival, 89.7% versus 91.9±%, respectively, (p = 0.25), but a significant difference in adjusted 10-year freedom from reintervention, 90.0±% versus 95.9%, respectively, (p < 0.01). Between 2007 and 2018, age and risk profile of patients undergoing surgical aortic valve replacement decreased, especially for patients treated with a biological prosthesis. The 120-day mortality decreased over time. Patients undergoing surgical aortic valve replacement nowadays have a risk of 120-day mortality of < 1% and 10-year freedom from valve-related reintervention of > 95%.

FastCCLasso: a fast and efficient algorithm for estimating correlation matrix from compositional data.

The composition and structure of microbial communities on the body surface are closely related to human health. The interaction relationship among microbes can help us understand the formation of the microecological environment and the biological mechanism by which microorganisms influence host health. With the help of high-throughput sequencing technologies, microbial abundances in a natural environment can be directly measured without the isolation of microorganisms in culture. Sequencing experiments in microbiome studies can measure the relative abundance of microbes, which is called compositional data. Although there are already many methods for correlation analysis for compositional data, the computation time or accuracy still needs to be improved for current microbiome studies. We develop a fast and efficient algorithm, called fastCCLasso, based on a penalized weighted least squares for inferring the correlation structure of microbes from compositional data in microbiome studies. We perform a large number of numerical experiments and the simulation results show that fastCCLasso outperforms its competitors in edge detection for inferring the correlation network. We also apply fastCCLasso for estimating microbial networks in microbiome studies and fastCCLasso provides a conservative network with comparable false discovery counts that are derived from shuffled data. FastCCLasso is open source and freely available from https://github.com/ShenZhang-Statistics/fastCCLasso under GNU LGPL v3.

Maximum tumor diameter and renal function can predict the declining surface dose rate after 177Lu-Dotatate: preliminary results of single institution in Japan.

This study aimed to develop a user-friendly prediction formula for dose rate adjustment after initial 177Lu-Dotatate therapy from a prospective observational study of patients. This study included consenting patients in a prospective observational study who underwent their firsttreatment in four cycles of 177Lu-Dotatate treatment at our hospital between January 2022 and February 2024. All patients received 7.4GBq of 177Lu-Dotatate. The prediction formula was derived from the regression analysis of tumor-related factors and renal function. Creatinine clearance was estimated using the Cockcroft-Gault equation in this study for renal function. Among the 13 patients (seven males, six females, median age: 59years), logarithmically transformed total tumor volume (cc) and maximum tumor diameter (mm) of primary tumors or metastases showed strong correlations (p < 0.001, R2 = 0.897). As such, the maximum tumor diameter was used as the tumor parameter in the prediction formula. Additionally, maximum tumor diameter and creatinine clearance showed strong (p < 0.001, R2 = 0.768) and moderate (p = 0.013, R2 = 445) correlations, respectively, with the ratio of the dose rate 5.5-h post-administration to the dose rate immediately post-administration (%) at 1m from the body surface. The resulting formula, 51.4 + 0.360 × maximum tumor diameter (mm) - 0.212 × creatinine clearance (ml/min), demonstrated an extremely strong correlation (p < 0.001, R2 = 0.937). The present study showed that the maximum tumor diameter and renal function affected the declining the dose rate of patients surface after 177Lu-Dotatate, which can inform post-administration dose rate management and potentially facilitate outpatient treatment in Japan.

Intraluminal release of citrullinated histone 3 from various cellular origins coincides with microvascular thrombosis in burn wounds.

Loss of perfusion in the burn wound might cause wound deepening and impaired healing. We previously showed persistent microvascular thrombosis coinciding with intraluminal neutrophils extracellular traps in human burned skin. This study investigates the presence of intraluminal citrullinated histone 3 (H3cit) from different cellular origins (neutrophils, monocytes, and lymphocytes) in relation to microvascular thrombosis of burn wounds. Eschar was obtained from burn patients (n = 18) 6-40 days postburn with a mean total burned body surface area of 23%. Microvascular presence of tissue factor (TF), factor XII (FXII) and thrombi was assessed by immunohistochemistry. Intramicrovascular cell death was analyzed via immunofluorescent microscopy, combining antibodies for neutrophils (MPO), monocytes (CD14), and lymphocytes (CD45) with endothelial cell markers CD31 and H3cit. Significantly increased microvascular expression of TF, FXII, and thrombi (CD31+) was found in all eschar samples compared with control uninjured skin. Release of H3cit from different cellular origins was observed in the lumen of the dermal microvasculature in the eschar tissue 7-40 days postburn, with release from neutrophilic origin being 2.7 times more abundant. Intraluminal presence of extracellular H3cit colocalizing with either MPO, CD14, or CD45 is correlated to increased microvascular thrombosis in eschar of burn patients.

An Analysis of Hospitalized Burn Injuries in a Burn Care Unit of Northern Bangladesh

Introduction: Burn injuries remain a significant public health issue, especially in low- and middle-income countries where comprehensive data is scarce. This study provides a detailed analysis of burn injuries in Northern Bangladesh, focusing on epidemiological characteristics and factors influencing burn severity and incidents. Methods: This retrospective study analyzed 477 cases of acute, unintentional burns recorded between January 2022 and December 2022 at the Rangpur Medical College Hospital's Burn and Plastic Surgery unit. Data on demographics, burn types, etiology, and severity were collected from hospital registers. Statistical analysis, including chi-square tests and logistic regression, was used to identify predictors of burn severity. Result: Of the 477 documented cases, females represented 62.05% (296 cases) and males 37.95% (181 cases). Flame burns predominated, comprising 70% of incidents, significantly impacting females engaged in cooking activities. The data revealed a distinct seasonal trend with a significant peak in January, where 40% (191 cases) of annual burn incidents occurred due to campfire exposure. The analysis further demonstrated that burns covering more than 30% of total body surface area (TBSA) were significantly associated with higher morbidity and mortality, with third-degree burns occurring in 92.9% of females compared to 55.8% of males. Logistic regression identified age (OR = 1.28, CI [1.13-2.71]), gender (OR = 1.75, CI [1.11-1.47]), and the cause of ignition (OR = 0.56, CI [0.41-0.76]) as significant predictors of burn severity. Conclusion: The findings emphasize the need for targeted interventions to address the high incidence of burns among young to middle-aged women, particularly through safer cooking practices and awareness campaigns. Additionally, public health strategies should consider seasonal risks and promote safer heating methods during colder months. This study underlines critical areas for intervention and highlights the importance of culturally tailored public health strategies to reduce burn injuries in Northern Bangladesh.

Serum Plasminogen Activator Inhibitor-1, α 1-Acid Glycoprotein, C-Reactive Protein, and Platelet Factor 4 Levels—Promising Molecules That Can Complete the “Puzzle” of the Biochemical Milieu in Severe Burns: Preliminary Results of a Cohort Prospective Study

Background: Burns represent a serious health problem, associated with multiple-organ failure, prolonged hospitalization, septic complications, and increased rate of mortality. The main aim of our study was to evaluate the levels of various circulating molecules in children with severe burns (more than 25% TBSA), in three different moments: 48 h, day 10, and day 21 post-burn. Materials and Methods: This study included 32 children with burns produced by flame, hot liquid, and electric arc and 21 controls. Serum plasminogen activator inhibitor-1 (PAI-1), α 1-acid glycoprotein (AGP), C-reactive protein (CRP), and platelet factor 4 (PF4) were detected using the Multiplex technique. Several parameters, such as fibrinogen, leucocyte count, thrombocyte count, triiodothyronine, thyroxine, and thyroid-stimulating hormone were also determined for each patient during hospitalization. Results: Significant statistical differences were obtained for CRP, AGP, and PF4 compared to the control group, in different moments of measurements. Negative correlations between CRP, AGP, and PF4 serum levels and burned body surface, and also the hospitalization period, were observed. Discussions: CRP levels increased in the first 10 days after burn trauma and then decreased after day 21. Serum PAI-1 levels were higher immediately after the burn and started decreasing only after day 10 post-burn. AGP had elevated levels 48 h after the burn, then decreased at 7–10 days afterwards, and once again increased levels after 21 days. PF4 serum levels increased after day 10 since the burning event. Conclusions: Serum CRP, AGP, PAI-1, and PF4 seem to be promising molecules in monitoring patients with a burn within the first 21 days.

Investigating the relationship between heat load and shade seeking behaviour in dairy buffaloes.

The study presented in this Research Communication aimed to investigate the relationship between physiological responses, body surface temperature and shade-seeking behaviour in Nili Ravi dairy buffaloes during summer months. We enrolled 60 buffaloes, and each animal was observed for three consecutive days starting before sunrise until they moved towards the shade structures. A repeated measures ANOVA was employed to assess the changes in physiological parameters and body surface temperature between the early morning and the occurrence of shade-seeking behaviour. The average temperature humidity index and heat load index during the behavioural monitoring period (0400 to 1200 h) were 81.3 ± 6.5 and 92.9 ± 17, respectively (mean ± sd). There was no significant difference in core body temperature between sunrise and the time of shade-seeking event. However, the buffaloes had a slightly higher respiration rate at the time of shade-seeking (19.2 vs. 22.4 breaths/min). In addition, body surface temperature, measured at the flank region, shoulder, base of the ear and forehead was significantly higher at the occurrence of shade-seeking behaviour compared to the early morning. On average, the buffaloes sought shade when the surface temperature was 2°C higher than the temperature recorded before sunrise. Overall, the current findings suggest that body surface temperature, rather than core body temperature was strongly associated with shade-seeking behaviour in dairy buffaloes. These findings could be useful in developing strategies to mitigate the effects of heat stress in dairy buffalo herds and thereby improve animal welfare.

Taxonomic notes on the genus Baetiella Uéno, 1931 (Ephemeroptera, Baetidae), with description of three new species from Thailand

Based on material recently collected in northern Thailand, the present study provides an updated of the genus Baetiella, including Gratia. It comprises six species in Thailand, three of them being new species: Baetiella (Gratia) narumonae, Baetiella (Gratia) sororculaenadinae, Baetiella (Baetiella) bispinosa, Baetiella (Baetiella) baeisp. nov., Baetiella (Baetiella) lannaensissp. nov. and Baetiella (Baetiella) bibranchiasp. nov.Baetiella (Baetiella) baeisp. nov. can be distinguished from other species by the reduction of the posteromedian protuberances on abdominal tergites I–III, the asymmetrical coniform terminal segment of labial palp, the distal margin of abdominal sternites VII–X each with a row of long, spatulate setae, the dorsal margin of femur with two long, robust setae distally. Baetiella (Baetiella) lannaensissp. nov. is diagnosed by the posteromedian protuberances present on tergites I–VIII, dorsal margin of femur with a regular row of long, rounded, ciliated setae and body surface covered with numerous, dense, rounded scale-like setae. Baetiella (Baetiella) bibranchiasp. nov. can be separated from other species by coxal gills present at the base of forelegs and midlegs. The molecular study based on the mitochondrial gene COI and a larval key to species of Thai Baetiella are also provided.

Assessment of aortic dilatation in Chinese children and adolescents with Turner syndrome: a single center experience

BackgroundPatients with Turner syndrome (TS) face an increased risk of developing aortic dilatation (AD), but diagnosing AD in children presents greater complexity compared to adults. This study aimed to investigate the application of various assessment indicators of AD in Chinese children and adolescents with TS.MethodsThis study included TS patients admitted to Shenzhen Children’s Hospital from 2017 to 2022. Cardiovascular lesions were diagnosed by experienced radiologists. Patients without structural heart disease were divided into different body surface area groups, then the Chinese TS population Z-score (CHTSZ-score) of the ascending aorta was calculated and compared with other indicators such as aortic size index (ASI), ratio of the ascending to descending aortic diameter (A/D ratio), and TSZ-score (Quezada’s method).ResultsA total of 115 TS patients were included, with an average age of 10.0 ± 3.7 years. The incidences of the three most serious cardiovascular complications were 9.6% (AD), 10.4% (coarctation of the aorta, CoA), and 7.0% (bicuspid aortic valve, BAV), respectively. The proportion of developing AD in TS patients aged ≥ 10 years was higher than that in those < 10 years old (16.6% vs. 1.8%, P = 0.009), and the proportion of patients with CoA or BAV who additionally exhibited AD was higher than those without these conditions (31.6% vs. 5.2%, P < 0.001). The ASI, A/D ratio, TSZ-score, and CHTSZ-score of the 11 patients with AD were 2.27 ± 0.40 cm/m2, 1.90 ± 0.37, 1.28 ± 1.08, and 3.07 ± 2.20, respectively. Among the AD patients, only 3 cases had a TSZ-score ≥ 2, and 2 cases had a TSZ-score ≥ 1. However, based on the assessment using the CHTSZ-score, 6 patients scored ≥ 2, and 5 patients scored ≥ 1. In contrast, the TSZ-score generally underestimated the aortic Z-scores in Chinese children with TS compared to the CHTSZ-score.ConclusionsThe applicability of ASI and A/D ratio to children with TS is questionable, and racial differences can affect the assessment of TSZ-score in the Chinese population. Therefore, establishing the CHTSZ-score specifically tailored for Chinese children and adolescents is of paramount importance.

Effectiveness of calcipotriol/betamethasone dipropionate aerosol foam in patients with small versus large plaque psoriasis in routine practice in South Korea.

Small plaque psoriasis is the typical form of chronic plaque psoriasis affecting adults in South Korea. The effectiveness of calcipotriol/betamethasone dipropionate (Cal/BD) aerosol foam for large and small psoriasis plaques has not previously been examined. We performed a post hoc analysis of a recent, 4-week observational study of Cal/BD aerosol foam use in routine clinical practice in South Korea. Investigator Global Assessment response ([IGA] 0/1 at week 4), Patient Global Assessment response ([PaGA] 0/1 at week 4), change in Psoriasis Area and Severity Index (PASI), changes in psoriasis symptom scores, change in the Dermatology Life Quality Index (DLQI), and the proportion of patients achieving DLQI ≤5 were analyzed for patients with small (≤5 cm; n = 131) or large (>5 cm; n = 35) baseline plaque size. IGA response rates were similar for patients with small and large plaques (59.5% and 51.4% respectively). Similarly, there was no significant difference between the small and large groups in mean change in PASI (-2.20 vs -3.34), the proportions of patients with DLQI ≤5 (62.3% vs 54.3%) or PaGA 0/1 (29.2% vs 40.0%). Mean improvements in DLQI (-4.04 vs -6.20) and in psoriasis symptoms including itching (-1.50 vs -2.83), sleep loss (-0.67 vs -1.89), dryness (-1.57 vs -2.97), scaling (-1.21 vs -3.57), and redness (-1.17 vs -3.11) were greater in patients with large plaques than those with small plaques. Itching and DLQI differences were not statistically significant after adjustment for baseline characteristics. Stratification by body surface area affected eliminated statistically significant differences between the groups for most outcomes. In conclusion, this analysis suggests that Cal/BD aerosol foam is an effective, well-accepted treatment for adult patients with the small plaques typical of chronic plaque psoriasis in South Korea, as well as for those with large plaques.

Psoriasis Area and Severity Index and its Correlation with Liver Function Test

Objective: To determine Psoriasis Area and Severity Index score and its association with LFT values in patients of psoriasis. Methodology: This cross-sectional study, was done on patients visiting the skin OPD of LUMHS Jamshoro/Hyderabad. Diagnosed patients of Psoriasis, aged between 18 and 50 years and both genders were included. A 5cc blood sample was collected from each individual to evaluate the LFT. Psoriasis Area and Severity Index (PASI) scores was defined based on the percentage of body surface area affected by psoriasis lesion. All the information was entered and analyzed using SPSS version 26. Results: The mean age of the patients was 44.81±11.10 years. Out of the total 102 patients, 74.5% were male patients and 25.5% were female. The mean duration of psoriasis was 6.46 ± 4.49 years. Out of all 32.4% had mild psoriasis (PASI &lt; 7), 40.2% had moderate psoriasis (PASI 8-12), and 27.5% had severe psoriasis (PASI &gt; 12). Regarding LFT values, 73.5% had elevated alanine transaminase (ALT), 32.4% had elevated aspartate transaminase (AST), 70.6% had elevated alkaline phosphatase (ALP), 68.6% had elevated bilirubin, and 67.6% had elevated gamma-glutamyl transferase (GGT). AST and GGT levels rise significantly linked to PASI (p- &lt;0.05). Conversely, for ALP and Bilirubin levels, there is no significant difference across severity of PASI (p- &gt;0.05). Conclusion: Patients with severe psoriasis exhibit a predisposition to hepatic dysfunction. Study observed abnormalities in liver function tests (LFT) among psoriatic patients, suggesting a potential link to liver disease development.

Deaths during Sexual Activity

Background: Deaths during sexual activities are a rarely identified phenomenon in forensic medicine practice. Most often, such deaths are classified as accidents or deaths due to the manifestation of certain diseases during sexual activity. It is important to rule out homicide or suicide as the cause of death when investigating sexual deaths. Determining the cause of death requires a comprehensive assessment of the evidence and circumstances and should not be based solely on autopsy findings. When determining the cause of death, it is necessary to evaluate the circumstances of the discovery, important evidence found near the body, the position of the deceased, the place where the deceased was found, and the characteristics of the environment. Cases: Case 1: A 65-year-old male was clothed in women’s underwear and was found hanging in a noose in a bedroom after a house fire. The autopsy revealed a ligature mark on the neck, bruises in neck muscles, tears in carotid arteries, and signs of acute pulmonary distension. The cause of death was determined to be suffocation due to neck compression by a ligature, compounded by significant alcohol intoxication, with additional postmortem burns covering 30% of the body surface area likely occurring after death. Case 2: A 55-year-old naked male was found without external injuries but with a plastic tube inserted into the rectum, causing a 2.5 cm rupture in the ileum. The perforation led to complications, including purulent diffuse peritonitis, intoxication, and acute cardiac and respiratory failure, resulting in death within 3-6 hours after insertion. Concurrent findings included atherosclerotic changes in the heart, internal organ hyperemia and edema, hepatic steatosis, renal cyst, and a lack of ethyl alcohol in blood but 0.17 ‰ presence in urine according to toxicology analysis. Conclusions: A detailed evaluation of all the evidence is very important in the forensic examination of the deceased during sexual activity. Therefore, to determine the cause of death, not only the autopsy data, toxicological and microscopic examinations of the deceased are important, but also the evaluation of all findings at the scene. The most common cause of death of an autoerotic nature is asphyxia, and the most commonly identified group of the dead are men aged around 40 years.

Physiological Changes in QRS Fragmentation in Athletes and Nonathletes without Cardiac Disease

Background/Objectives: QRS fragmentation has not been linked with increased mortality in individuals without known cardiac disease. We aimed to investigate the physiological determinants of QRS fragmentation in individuals without cardiac disease. Methods: Study participants were 163 (54 athletes, 109 nonathletes) asymptomatic individuals with QRS fragmentation but without cardiac disease. QRS fragmentation was assessed in the supine position after deep inspiration or standing up and during exercise. The changes in QRS fragmentation were evaluated over a median follow-up period of 2.3 (0.8–4.9) years. Results: The most common lead with QRS fragmentation was III (63.0% in athletes, 61.5% in nonathletes), immediately followed by V1 (50.0%) and aVF (42.6%) in athletes and aVF (55.0%) in nonathletes. QRS fragmentation in V1 was more frequent in athletes compared to nonathletes (p &lt; 0.001). Among athletes, the presence of QRS fragmentation in V1 could be independently predicted by increased RVOTproxi (right ventricular outflow tract proximal diameter indexed to body surface area) (p &lt; 0.001). Among individuals with QRS fragmentation in V1, deep inspiration resulted in disappearance of QRS fragmentation more frequently in nonathletes compared to athletes (100% vs. 20%, p = 0.003). Deep inspiration resulted in disappearance of QRS fragmentation in aVF (p &lt; 0.001). The presence of QRS fragmentation in II or aVF was associated with increased body mass index (BMI) (p = 0.003). Among athletes without QRS fragmentation in V1 at baseline, the appearance of QRS fragmentation in V1 at the end of follow-up was associated with greater training age (p = 0.034). Among individuals with QRS fragmentation in aVF at baseline, the disappearance of QRS fragmentation in aVF at the end of follow-up was associated with greater reduction in BMI (p = 0.008). Conclusions: The characteristic feature of QRS fragmentation in athletes was the presence of QRS fragmentation in V1, which was associated with RVOTproxi. The persistence of QRS fragmentation in V1 after deep inspiration could serve as a specific marker of exercise-training-related cardiac adaptation. The presence of QRS fragmentation in the leads of the frontal plane was influenced by BMI and respiration phase.