Doubtful Cases Research Articles

Adverse Reactions to Cosmetic Fillers in the Oral and Maxillofacial Region: Clinico-Pathological, Histochemical, and Immunohistochemical Characterization.

Cosmetic injections are increasing, as their complications, which can be misdiagnosed as neoplastic lesions. This study aimed to detail clinical, pathological, histochemical, and immunohistochemical features of adverse reactions to cosmetic fillers in the oral and maxillofacial region. Samples were retrieved from five pathology laboratories. Hematoxylin-eosin (H&E), Alcian Blue, Sirius Red, and Toluidine blue stains were performed, as well as immunohistochemistry for CD68, CD3, and CD20. H&E was evaluated under polarization. Descriptive statistics were performed. Twenty-three cases were included. Polymethyl-methacrylate was the most common material. Most reactions affected women, lips and were asymptomatic, with a variable time of evolution, presenting as nodules. Materials had different shape and size on H&E. Giant cells were commonly found, except in silicone and hyaluronic acid. Foreign-body granuloma was frequent in polymethyl-methacrylate. Calcium hydroxyapatite and poly-L-lactic acid were refractile under polarized light. Hyaluronic acid and polyacrylamide hydrogel were metachromatic by Toluidine blue. Alcian blue was positive in all cases of hyaluronic acid. Mast cells were detected in all materials, except hyaluronic acid and polyacrylamide hydrogel. Eosinophils were rarer than mast cells. Numerous CD68-positive cells were seen in all cases. All cases had CD3-positive cells, with variable amounts. CD20 was scant or negative in most cases. An evident macrophage reaction is observed in all aesthetic fillers, frequently associated with giant cell formation. Despite similarities, there are specific features of each material and the host response that assist the correct histopathological diagnosis. Immunohistochemistry for CD68 and Toluidine blue stain are useful in doubtful cases.

Can unilateral-transforaminal lumbar interbody fusion replace the traditional transforaminal lumbar interbody fusion procedure for lumbar degenerative disc diseases?: a single center matched case-control mid-term outcome study.

Matched case-control study. To evaluate the midterm outcomes of unilateral pedicle screw fixation (UPSF) versus bilateral pedicle screw fixation (BPSF) in transforaminal lumbar interbody fusion (TLIF) procedure, ascertain efficacy of UPSF in adequately decompressing contralateral foramen+spinal canal and reducing rate of adjacent segment degeneration (ASD) at 4-8-year follow-up (FU). Previous meta-analyses found no significant differences between UPSF and BPSF regarding fusion rates, clinical and radiological outcomes; however, few studies have reported higher rates of cage migration/subsidence and pseudoarthrosis in the UPSF. No study has evaluated the impact of UPSF on indirect decompression and ASD. Retrospective analysis of 319 patients treated with UPSF vs. 331 patients treated with BPSF between 2012 to 2020. Clinical and radiological outcomes were evaluated at 6 months, 1 year, 2 years, and 4 years postoperatively. X-rays were used to assess fusion+ASD and computed tomography scans in doubtful cases. Magnetic resonance imaging was used at last FU to determine cross-sectional area of cord (CSA), foraminal height (FH), and width (FW) restoration. The mean FU duration was 50 months (range, 44-140 months). In UPSF, CSA increased by 2.3 times from preoperative values; FH and FW increased by 25% and 17.5%, respectively, at last FU (p<0.001); fusion rate was 94.3%, comparable to BPSF (similar CSA, FW, FH, 96.4% fusion rate). In UPSF, adjacent disc height remained stable, from preoperative 11.39±2.03 to 10.97±1.93 postoperatively at 4 years and 10.03±1.88 at 8 years. BPSF showed ASD in 14 (4.47%) vs. three patients (1.06%) in UPSF (p<0.04). Complication rates were similar (6.58% UPSF vs. 6.04% BPSF, p>0.05). UPSF-TLIF is comparable to BPSF in terms of patient-reported clinical outcomes, fusion rates, and complication rates while being superior in terms of lesser ASD. UPSF enables radiologically and clinically significant contralateral indirect neural foraminal decompression and canal decompression without disturbing the contralateral side anatomy, unlike BPSF.

Forming a Definition of a Town. Poland in the Context of Universal History

In the light of the current state of research, it does not seem possible to create a universal definition of town, covering all eras and cultures. However, if the field of analysis is narrowed, it becomes possible and desirable. As part of the work on ontological foundations of geographic information systems for the history of Poland, a tool has been developed to distinguish between basic (villages) and higher (towns) units of the settlement network. Three basic criteria are assessed: whether a settlement was considered a town by its contemporaries, whether it was large and complex compared to a village, and whether it had the legal status of a town. In different periods and legal systems, each of these criteria may have had different meanings, and the combined consideration of all three allows for the classification of doubtful cases. The second part of the article predicates the application of such a definition in the analysis of the urban network of twelve counties (within their contemporary boundaries) in four time sections: 1200, 1600, 1900 and 1939. Boundary situations included primarily early Piast townships with different functions, followed by agglomerations consisting of more than one urban commune in 1600 and, finally, so-called ‘urban settlements’ in the Congress Kingdom in 1900. The article also determines the number of towns in a given area at the indicated point in time. It seems particularly important to have an unambiguous and consistent classification of settlement units for a long period and a relatively large area, particularly in view of the creation of historical geoportals.

Diagnostic Performance of Artificial Intelligence in Chest Radiographs Referred from the Emergency Department.

The increasing integration of AI in chest X-ray evaluation holds promise for enhancing diagnostic accuracy and optimizing clinical workflows. However, understanding its performance in real-world clinical settings is essential. In this study, we evaluated the sensitivity (Se) and specificity (Sp) of an AI-based software (Arterys MICA v29.4.0) alongside a radiology resident in interpreting chest X-rays referred from the emergency department (ED), using a senior radiologist's assessment as the gold standard (GS). We assessed the concordance between the AI system and the resident, noted the frequency of doubtful cases for each category, identified how many were considered positive by the GS, and assessed variables that AI was not trained to detect. We conducted a retrospective observational study analyzing chest X-rays from a sample of 784 patients referred from the ED at our hospital. The AI system was trained to detect five categorical variables-pulmonary nodule, pulmonary opacity, pleural effusion, pneumothorax, and fracture-and assign each a confidence label ("positive", "doubtful", or "negative"). Sensitivity in detecting fractures and pneumothorax was high (100%) for both AI and the resident, moderate for pulmonary opacity (AI = 76%, resident = 71%), and acceptable for pleural effusion (AI = 60%, resident = 67%), with negative predictive values (NPV) above 95% and areas under the curve (AUC) exceeding 0.8. The resident showed moderate sensitivity (75%) for pulmonary nodules, while AI's sensitivity was low (33%). AI assigned a "doubtful" label to some diagnoses, most of which were deemed negative by the GS; the resident expressed doubt less frequently. The Kappa coefficient between the resident and AI was fair (0.3) across most categories, except for pleural effusion, where concordance was moderate (0.5). Our study highlighted additional findings not detected by AI, including 16% prevalence of mediastinal abnormalities, 20% surgical materials, and 20% other pulmonary findings. Although AI demonstrated utility in identifying most primary findings-except for pulmonary nodules-its high NPV suggests it may be valuable for screening. Further training of the AI software and broadening its scope to identify additional findings could enhance its detection capabilities and increase its applicability in clinical practice.

Flow Cytometry for the Detection and Quantification of Mast Cells in Lymph Nodes: A Prospective Study in 64 Dogs With Mast Cell Tumour.

Nodal metastasis is a negative prognostic factor in dogs with mast cell tumours (MCTs), thus early detection enables more informed decision-making and provides valuable prognostic information. The aim of this study is to assess the concordance between histopathologic findings of LNs and cytology and flow cytometry (FC), respectively, and to evaluate the ability of FC to differentiate between metastatic (HN2-HN3) and non-metastatic (HN0-HN1) LNs. Overall, 117 LNs from 64 dogs with first occurring MCTs were submitted for cytology, histology and FC. LNs were cytologically and histologically classified according to Krick and Weishaar systems, respectively. Using FC, mast cells (MCs) were identified as IgE+ CD117+ CD5- CD21- cells and quantified as a percentage. When compared with histologic classification, cytology showed an accuracy of 88.2% in distinguishing between metastatic and non-metastatic LNs but did not detect 25.3% of metastatic cases. FC revealed an increase in the median percentages of MCs across histologic classes, progressing from HN0 to HN3. ROC curves pinpointed 0.3% as the optimal cut-off for distinguishing between metastatic and non-metastatic LNs, with an accuracy of 84.3%. A 1.1% cut-off proved valuable in identifying HN3 LNs. The combined interpretation of cytology and FC increased accuracy to 92.2%. An algorithm for guiding the combined interpretation of cytology and FC is suggested based on these findings. In conclusion, FC proves beneficial in enhancing the early detection of metastatic LNs, particularly when utilised alongside cytology. Histopathology remains essential for confirmation, enabling the discrimination of HN classes or, in doubtful cases, for the detection or exclusion of nodal metastases.

Flow cytometry of non-hematopoietic cells in canine effusions.

The identification of non-hematopoietic cells in effusions is a diagnostic challenge in cytology. Biopsies from mesothelium or primary lesions are infrequently performed in clinical settings and immunochemistry on smears or immunohistochemistry on cell blocks are the most common ancillary test to refine the cytological diagnosis. Cavitary effusions are an ideal matrix for flow cytometry and the availability of a cytometric panel to describe non-hematopoietic cells would represent a useful tool. Here we present the results of the flow cytometric and immunohistochemical determination of cytokeratin (CK), vimentin (VIM) and desmin (DES) in 36 canine effusions. The concordance between the two methods was perfect for CK (100%), substantial for VIM (77.8%), and almost perfect for DES (97.2%). The panel was interpreted to define the epithelial (CK+VIM-DES-), mesothelial (CK+VIM+DES+), or mesenchymal (CK-VIM+DES-) origin of the cells. Unexpected profiles were considered doubtful and observed patterns were individually discussed. The concordance of the panel interpretation between two methods was 75%. The evaluation of discordant and doubtful cases suggests a lower sensitivity of flow cytometry in detecting VIM expression and revealed a high frequency of VIM+ epithelial cells, variable expression of VIM in mesothelial cells, and an important role of DES in excluding an epithelial origin when positive. Multicentric studies based on histopathological diagnoses are necessary to confirm these findings and evaluate the diagnostic utility of the panel to refine cytological diagnosis. Our results show that flow cytometry can be a timesaving alternative to IHC on cell blocks in clinical settings to detect CK, VIM and DES expression. The interpretation of the panel is similar in most cases; however, occasional discordant results, particularly for VIM, may occur.

Rhinophyma – Case Report of a 67-Year-Old Male with Extensive Nodular Changes of the External Nose in the Course of Rosacea

&lt;b&gt;Introduction:&lt;/b&gt; Rhinophyma is a particularly advanced form of rosacea. It typically affects middle-aged and elderly men. It develops due to significant hypertrophy of the sebaceous glands, blood vessels, and connective tissue of the nasal skin. The external nose becomes enlarged, with the skin becoming thickened, fibrous, and oily. When pressure is applied, a mixture of sebum and blood may be expelled. Facial deformity often leads to social withdrawal in affected individuals. In extreme cases, it can lead to nasal passage obstruction.&lt;b&gt;Case report:&lt;/b&gt; This paper discusses the case of a 67-year-old male patient with a long history of rosacea. A diagnosis of rhinophyma was established, and surgical treatment was employed, yielding satisfactory results. Various methods of treating rhinophyma are described.&lt;b&gt;Discussion:&lt;/b&gt; The diagnosis of rosacea is based on medical history and characteristic skin changes on the face, with histopathological examination being decisive in doubtful cases. The etiopathogenesis of the condition is not well understood. Risk factors may include a positive family history of rosacea, improper treatment of rosacea, smoking, and excessive alcohol consumption.&lt;b&gt;Conclusions:&lt;/b&gt; The treatment of choice for rhinophyma is surgical intervention. Patients should be informed about the possibilities that modern medicine offers in the treatment of rhinophyma. This can improve both nasal patency and external appearance, significantly enhancing the patient’s psychological comfort.

Traditional Biomarkers in Patients with Pancreatic Cancer Staged by Computed Tomography and Endoscopic Ultrasound: Is There Still a Role in the Molecular Era?

Serum carbohydrate antigen 19-9 (Ca19-9) is the only approved biomarker approved for the screening and diagnosis of pancreatic cancer (PC), but its value remains controversial. The aim of our study is to evaluate the role of CA 19-9 in the management of PC patients in jaundiced patients staged by both Computed Tomography (CT) and Endoscopic Ultrasound (EUS). Additionally, we evaluated traditional cholestasis marker behavior. Medical records of 73 patients have been retrospectively reviewed. We considered tumor size, tumor stage, CA 19-9, cytolysis, and cholestasis biomarkers. All patients underwent CT scan for staging. EUS +/− fine-needle biopsy (FNB) was performed in doubtful cases. Median alkaline phosphatase (ALP) and y-glutamyltransferase (GGT) levels were significantly lower compared to baseline after the biliary drainage (204 vs. 465 U/L, p &lt; 0.0001, 204. U/L vs. 608.5, p &lt; 0.0001, respectively), whilst no differences were observed for CA 19-9 levels. CA 19-9 showed significant association with the tumor stage in the pre-drainage setting. CT and EUS showed a low agreement in estimating tumor size (mean difference 4.8 mm 95% LoA −10.82–20.38). We did not find any significant correlation between CA 19-9 and bilirubin levels (r = −0.05, p = 0.7). In our cohort, survival rate was lower in patients with higher CA 19-9 levels (log rank p = 0.007). CA 19-9 has some limitations as a biomarker in the PC setting, thus it cannot address the treatment strategy alone. Nonetheless, it provides valuable information, and is not replaceable for the time being.

Intuitionistic fuzzy divergence for evaluating the mechanical stress state of steel plates subject to bi-axial loads

The uncertainty that characterizes the external mechanical loads to which any connection plate in steel structures is subjected determines the non-uniqueness of the isochoric deformation distributions. Since the eddy currents induced on the plates produce magnetic field maps with a high fuzziness content, similar to those of the isochoric deformations, their use can be exploited to evaluate the extent of the external load that determines a specific induced current map. Starting from an approach known in the literature, according to which the map-external load association is operated through fuzzy similarity computations, in this paper, we generalize this method by reformulating it in terms of intuitionistic fuzzy logic by proposing a classification based on divergence computations. Our approach, acting adaptively on the fuzzification of the maps, results in a better classification percentage, besides significantly reducing the presence of doubtful cases due to the uncertainty of each applied load. Furthermore, a FEM software tool was developed, which turned out to be, to a certain extent, a substitute for the experimental procedure, notoriously more expensive. Even if the procedure was applied on plates subjected to bi-axial loads, it could be used for other types of loads since the classification operator processes the eddy current maps exclusively, regardless of their cause.

Аналіз осередків скостеніння діафіза плечової кістки у плодів 20-32 тижні гестації

Nowadays, the assessment of the length of the femur and humerus is preferred, which plays a key role in doubtful cases to determine the age of the fetus in the second or third trimester of intrauterine development. The aim of the study was to evaluate the characteristics of ossification of the right and left humeral diaphysis in fetuses at 20-32 weeks of gestation for assessing the age of the fetus. Materials and methods. Plain radiographs and computed tomography scans of 52 human fetuses at 20-32 weeks of gestation were analyzed to determine the characteristics of humeral ossification in human fetuses. The results of the study were statistically analyzed using Excel. The results are presented as statistical means with standard deviations. Student's t-test for independent variables and one-way analysis of variance were used to compare means. Results. In fetuses of 20-32 weeks of gestation, the average length of ossification of the right humerus increases from 21.26±0.50 mm to 40.04±0.24 mm, and the left humerus - from 21.64±0.23 mm to 40.52±0.05 mm. The analysis of the proximal transverse diameter of the diaphysis of the right humerus showed that in fetuses aged 20-32 weeks, this indicator increases from 3.50±0.08 mm to 6.59±0.04 mm (for the right humerus) and from 3.56±0.04 mm to 6.67±0.01 mm (for the left humerus). The cross-sectional diameter of the middle part of the diaphysis of the right humerus increases from 2.67±0.06 mm to 5.02±0.03 mm, and that of the left humerus from 2.71±0.03 mm to 5.08±0.01 mm. The transverse diameter of the distal part of the diaphysis of the right humerus increased from 3.25±0.08 mm to 6.16±0.04 mm, and the left humerus - from 3.33±0.04 mm to 6.24±0.01 mm. Conclusions. Based on the correlation coefficient, which indicates the presence of a strong direct correlation, we can conclude that linear regression models adequately describe the dependence of the length of ossification of the humeral diaphysis, proximal transverse, middle and distal transverse diameters of the humerus on fetal age. In human fetuses aged 20-32 weeks of gestation, no sex differences were found in the morphometric parameters of the humeral ossification foci. The obtained morphometric data of the foci of ossification of the diaphysis of the humerus can be considered as normative for the corresponding weeks of gestation and can be used for the assessment of the age of the fetus and for the ultrasound diagnosis of congenital malformations. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Role of Ultrasound in Diagnosis of Fibrocystic Breast Disease

Background: Fibrocystic breast disease is the most typical benign breast disease, which is seen in women worldwide with features of pain and feeling of nodules. Its diagnosis is based on clinical symptoms, ultrasound, mammography, and in doubt cases, biopsy is indicated. For assessment of the breast, we clinically examined the breast, axilla, and both supra and infraclavicular regions for lymph node assessment, followed by ultrasound examination. Detection of lesions in any breast quadrant assessed by BIRADs, Breast Imaging Reporting, and Data System grouped in five brackets. Scanning by sonography using B-mode and Doppler study was improved for detecting and characterizing benign and malignant lesions. Objective: To assess a breast lesion by ultrasound with features suggestive of a benign or malignant nature. Method: This study included 210 women aged 20 - 45 who visited a clinic from October 2020 to April 2022 and were examined by ultrasound machine Samsung HS50 (KOREA) with an LA3-14AD probe. B-mode images obtained detection of the lesion, and we also used Doppler ultrasound for assessment of the vascularity of the lesion. The BI-RADS system was used for the categorization of all findings. Result: In 210 women, complaints of lumps were involved in our study. Imaging by B-mode ultrasound using the Doppler study assesses the vascularity of the lesion and provides more characterization of benign and malignant lesions. By B–mode imaging, 99 patients had regular ultrasound study, and 79 patients had simple cysts that appeared well defined, had familiar outlines, and had an anechoic rounded or oval shape with posterior enhancement. Twenty-eight patients with fibroadenoma visualized as round or oval-shaped hypoechoic lesions horizontally oriented to the planes of the breast with lateral shadowing. 2 patients had complex cysts that appear as well-defined, irregular outlines, rounded shape, a thick wall with internal echoes with posterior enhancement. 2 patients have a malignant lesion that appears ill-defined rough outline vertically oriented with breast planes and show posterior shadowing. Conclusion: Ultrasound was established as the most suitable imaging modality for the categorization of breast lesions and exclusion of malignancy, which is helpful for evading unnecessary biopsies.

PATIENT WITH CHRONIC CORONARY SYNDROME: USE OF MULTIMODAL IMAGING FOR CORRECT DIAGNOSIS AND TREATMENT

Abstract In the context of CCS, CCTA allows us to discriminate with almost certainty between patients with the absence of disease. In case of a positive test, the characteristics of the plaque allow to stratified risk of developing future events. In doubtful cases it is necessary to resort to a multimodal imaging strategy for the correct diagnosis. We present the case of a 63-year-old hypertensive and dyslipidemic man who started presenting two months ago episodes of asthenia associated with tachycardia and jugular constriction after taking the usual CCB therapy. With a pre-test probability of 26%, a CCTA scan was requested which highlighted a non-calcific fibrous plaque (Image 1) at the level of the middle circumflex inducing a moderate stenosis (Cad-Rads 3). The patient underwent coronary angiography which confirmed this lesion and also highlighted a similar one downstream of the first. (Image 2) The OCT evaluation showed: 7 mm eccentric fibrous proximal plaque with evidence of multiple intimal layers (Healed plaque) in its distal third and with evidence of a medial-intimal flap involving three quadrants in the proximal two thirds (270°), with current intact endothelium and presence of neo-angiogenesis; MLA 2.33 mm² and AS 70%. Picture compatible with healed spontaneous dissection of the vessel. (Image 3) The subsequent 12 mm concentric plaque (360° involvement of the vessel) had a predominantly lipid component with macrophages and fibrous cap of 60 µm, MLA of 2.3mm² and AS 72%. Panel compatible with high risk plaque. (Image 4) It was decided to implant a 3.5x26mm drug-eluting stent through OCT-guided PCI with final MSA of 7.62 mm², stent expansion of 81%, absence of dissections at the edges and residual distal edge plaque with MLA of 7.6 mm². (Image 5). Conclusions Healed plaques are more frequent in patients with CCS and represent a plaque complicated by medial-intimal ulceration subsequently healed by neo-endothelialization. On CCTA they appear as non-calcific fibrous plaques with an intermediate density expressed in Hounsfield Units but the definitive diagnosis can only be obtained using an Intravascular Imaging method (OCT in the case presented). The patient appears asymptomatic after resuming his usual antihypertensive therapy at 30-day FU.

Risk score model to automatically detect prostate cancer patients by integrating diagnostic parameters.

Prostate cancer (PCa) is one of the prevailing forms of cancer among men. At present, multiparametric MRI is the imaging method for localizing tumors and staging cancer. Radiomics plays a key role and hold potential for PCa detection, reducing the need for unnecessary biopsies, characterizing tumor aggression, and overseeing PCa recurrence post-treatment. Furthermore, the integration of radiomics data with clinical and histopathological data can further enhance the understanding and management of PCa and decrease unnecessary transfers to specialized care for expensive and intrusive biopsies. Therefore, the aim of this study is to develop a risk model score to automatically detect PCa patients by integrating non-invasive diagnostic parameters (radiomics and Prostate-Specific Antigen levels) along with patient's age. The proposed approach was evaluated using a dataset of 189 PCa patients who underwent bi-parametric MRI from two centers. Elastic-Net Regularized Generalized Linear Model achieved 91% AUC to automatically detect PCa patients. The model risk score was also used to assess doubt cases of PCa at biopsy and then compared to bi-parametric PI-RADS v2. This study explored the relative utility of a well-developed risk model by combining radiomics, Prostate-Specific Antigen levels and age for objective and accurate PCa risk stratification and supporting the process of making clinical decisions during follow up.

Recognising inaccuracies in Australian suicide and 'hidden suicide' data.

To examine the effects of revision of Australian mortality statistics every year since 2007 on numbers and rates of suicide and 'hidden suicide'. Nine months after the end of each year, the Australian Bureau of Statistics releases preliminary statistics concerning deaths registered in that year, together with revised and finalised data regarding previous years. Numbers and rates of suicide and of deaths coded to selected categories of accidental, undetermined and unknown cause deaths were tabled. Upward revision of suicide and accidental drug poisoning death numbers, three years after first release, show that true rates are substantially higher than initially released data suggested. Concomitant downward revision of rates of undetermined and unknown cause deaths supports evidence that at first release some suicides are coded to these categories. Australia's finalised suicide data are likely to be more accurate than equivalent data from nations that do not revise mortality data. More comprehensive investigation (including verbal or psychological autopsy) in doubtful cases in Australia and elsewhere would probably lead to reported suicide rates being higher.

Trachyonychia in Children: A Comprehensive Review with Recent Updates

Trachyonychia also known as 20-nail dystrophy presents as roughness of nail plate associated with longitudinal ridging giving a sandpaper-like appearance. It has two subtypes: opaque variety and shiny variety. It commonly presents in the pediatric age group 3–12 years but can present at any age. It can be idiopathic or associated with cutaneous or systemic conditions. Alopecia areata, atopic dermatitis, vitiligo, and lichen planus are some of the commonly associated conditions. Diagnosis is clinical and in doubtful cases, biopsy has a role. Onychoscopy as a novel diagnostic modality can be used. Spontaneous resolution is seen in the majority of pediatric patients, so counseling, reassurance, and active nonintervention can be tried. Treatment is mainly for cosmetic concerns or when associated with some systemic conditions. Various treatment modalities are available with variable efficacy. Topical treatment options include tazarotene, topical steroid, and calcipotriol/betamethasone combination, whereas systemic agents such as oral mini-pulse steroid, methotrexate, cyclosporine, and low-dose acitretin have shown beneficial role. Novel treatment modalities such as the use of tofacitinib, fluocinonide 0.05% with bifonazole 1% cream, combination of fractional CO2 laser with topical therapy, and alitretinoin have shown promising results.

Tens of Thousands of American Academics on the Editorial Boards of Journals Run by Predatory Publishers

Between August 2022 and March 2023, the names and affiliations of 2183 American academics were found on the editorial boards of journals owned by nineteen predatory publishers. A survey email went out to 905 of them, and 195 replies were received. Twenty-six replies were uninformative. Sixty-five respondents confirmed that they served knowingly and willingly, ninety-one reported that their names were being used without their knowledge, and thirteen said that their names were being used despite requests to have them removed. Based on these results, a minimum estimate of the number of academics serving on the editorial boards of corrupt publishers runs into the tens of thousands, while the maximum exceeds ninety thousand. The former estimate uses very stringent criteria to define a predatory publisher, excluding all moderate, minor, and doubtful cases. This situation should be intolerable. The academic community is urged to take legal action.

Diagnostic pathways in acute appendicitis: Clinical score plus ultrasound outperform CT scan or upfront surgery, especially in doubtful cases.

Controversies remain on the diagnostic strategy in suspected AA, considering the different settings worldwide. A prospective observational international multicentric study including patients operated for suspected AA with a definitive histopathological analysis was conducted. Three groups were analyzed: (1) No radiology; (2) Ultrasound, and (3) Computed tomography. The aim was to analyze the performance of three diagnostic schemes. Three thousand and one hundred twenty three patients were enrolled; 899 in the no radiology group, 1490 in the US group, and 734 in the CT group. The sex ratio was in favor of males (p<0.001). The mean age was lower in the no radiology group (24years) compared to 28 and 38years in US and CT-scan groups, respectively (p<0.001). Overall, the negative appendectomy rate 3.8%: no radiology group (5.1%) versus US (2.9%) and CT-scan (4.1%) (p<0.001). The sensitivity and specificity analysis showed the best balance in clinical evaluation+score+US. These data reach the best results in those patients with an equivocal Alvarado score (4-6). Inverse probability weighting (IPW), showed as the use of ultrasound, is significantly associated with an increased probability of formulating the correct diagnosis (p 0.004). In the case of a CT scan, this association appears weaker (p 0.08). The association of clinical scores and ultrasound seems the best strategy to reach a correct preoperative diagnosis in patients with clinical suspicion of AA, even in those population subgroups where the clinical score may have an equivocal result. This strategy can be especially useful in low-resource settings worldwide. CT-scan association may improve the detection of patients who may potentially be submitted to conservative treatment.

Histopathologic and transmission electron microscopic findings in monkeypox cutaneous lesions.

a few pathologic and ultrastructural findings of monkeypox skin lesions are available in the literature. To integrate such evidence, we aimed to describe the pathologic features of monkeypox skin lesions and to show monkeypox virions by transmission electron microscopy (TEM). we studied the cutaneous biopsies of three patients affected by monkeypox during the 2022 monkeypox outbreak. Skin biopsies have been collected only from body sites with a recent laboratory-confirmed mpox virus infection, defined by a polymerase chain reaction (PCR) positive result in specimens taken through skin swabs. in all the samples the epidermis showed keratinocytes ballooning degeneration; perivascular/periadnexal infiltrates composed of neutrophils and lymphocytes were observed in the deep dermis. Immunohistochemistry showed that the infiltrate was mostly composed of CD3+ T-cells. TEM revealed monkeypox virus-like particles in various stages of morphogenesis in the dermis and epidermis; virions were interspersed among keratinocytes and within their cytoplasm. At the intracellular level, virions showed a biconcaveshaped central core, surrounded by lateral bodies and an external membrane; they also appeared as rectangular, brick-shaped, or oval particles with eccentric nucleoids. The histologic features of our skin samples confirmed the few other studies on this topic, except for the eosinophilic inclusions of the cytoplasm of keratinocytes (Guarnieri's bodies). the role of molecular biology is crucial for monkeypox diagnosis but when it is not disposable and/or in doubtful cases, skin biopsy and TEM may be helpful to establish the diagnosis.

An Observational Study to Correlate the Histopathological and Dermoscopic Features in Leprosy Patients in a Tertiary Care Hospital.

Leprosy is a chronic granulomatous infection with varied clinical presentations. Dermoscopy is a noninvasive technique widely used in the diagnosis of various skin diseases. To see the correlation between the clinical and dermoscopic features with the histopathological findings in leprosy. A prospective observational study was conducted on clinically suspected leprosy patients attending the dermatology outpatient department (OPD) for 18 months. Representative lesions were observed by dermoscopy, and a biopsy was performed, followed by histopathology for final diagnosis. Patients were categorized by Ridley-Jopling classification. A total of 70 clinically suspected leprosy patients were included in the study. Amongst 70 cases, 56 cases were diagnosed as leprosy by dermoscopy, and 53 cases were confirmed as leprosy by histopathology (hematoxylin and eosin [H and E] staining and Fite-Faraco staining). The other six cases were diagnosed as other nonspecific dermatitis by histopathological findings. Eleven cases that were dermoscopically negative were also confirmed by histopathology to be truly negative. There are three inconclusive cases of dermoscopic findings, which were diagnosed as mid-borderline leprosy by histopathology. Dermoscopic and histopathological correlation was found above 87% in all types of leprosy except mid-borderline leprosy, which showed only a 25% correlation. Dermoscopy is a useful noninvasive tool to assess lesions of leprosy, requires less time for diagnosis, skin features are magnified several times and may become evident before clinical presentation. It definitely helps to reduce the number of biopsies in case of diagnosis of leprosy. However, in doubtful cases, histopathology is required for definitive diagnosis as it is the gold standard to date.

Dermoscopic Perspective of Pityriasis Versicolor in a Cross-Sectional Study.

Pityriasis versicolor is a common superficial fungal infection which is usually easily diagnosed with Wood's lamp examination and 10% potassium hydroxide mount. However, these modalities have varying sensitivity and specificity. This study aimed to ascertain the dermoscopic features of pityriasis versicolor lesionally as well as perilesionally using dermoscopy, a non-invasive diagnostic tool. In this cross-sectional study, consecutive patients with pityriasis versicolor underwent dermoscopic examination of lesions and 2 cm around lesions, noting lesional and perilesional features. Semi-objective grading of pigmentation, scaling, and vascularity was done. The association between parameters was determined using heat maps and violin plots with Kolmogorov-Smirnov test. Lesional analysis was performed since lesions at different sides showed disparate features. A total of 353 lesions from 233 patients (males = 150/233; 64.38% and females = 84/234; 36.05%) were studied. On lesional dermoscopy, pigmentary and scaling abnormalities were universal. 258/353 (73.1%) of lesions showed vascular abnormalities. Perilesionally, scaling (223/353; 63.17%) followed by pigmentation (205/353; 58.07%) and vascular changes (111/353; 31.44%) constituted the most common dermoscopic abnormalities and were noted in 294/353 (83.29%) of lesions overall. Increased disease duration corresponded with increased intensity of perilesional pigmentation alterations, perifollicular (P = 0.04), and follicular scales (P = 0.02). Awareness of dermoscopic features could improve the diagnostic accuracy in doubtful cases of pityriasis versicolor. Vascular findings are common and may point to an underlying inflammatory pathogenesis. Perilesional findings constitute early dermoscopic features of pityriasis versicolor and hint at the need for treatment beyond the confines of lesions. Larger follow-up studies and research into immunopathogenesis may be of further benefit.