Clinical Photographs Research Articles

Calibration and reliability testing of a novel asynchronous photographic plaque scoring system in young children.

The Simplified Oral Hygiene Index for Maxillary Incisors (OHI-MIS) is a novel plaque scoring system adapted for young children. This study describes calibration training and testing used to establish the inter- and intra-rater reliability for OHI-MIS measured from clinical photographs. Two raters from the Coordinated Oral Health Promotion Chicago (CO-OP) and one from the Behavioral EConomics for Oral health iNnovation (BEECON) randomized controlled trials (RCTs) underwent calibration with gold standard raters, followed by annual re-calibration. Raters from CO-OP also completed inter-rater reliability testing; all three raters completed intra-rater reliability testing rounds. Photographs were obtained from children aged 9-39 months. All three raters achieved greater than 0.77 Lin's Concordance Correlation (LCC) versus gold standard consensus during calibration. All three raters had LCC ≥0.83 at recalibration 1 year later. CO-OP trial raters scored 604 photos (151 sets of 4 photographs); mostly both raters were somewhat/very confident in their scoring (≥89%), describing the most photos as "clear" (90% and 81%). The CO-OP inter-rater LCC for total OHI-MIS score was 0.86, changing little when low quality or confidence photos were removed. All three raters demonstrated high intra-rater reliability (≥0.83). The OHI-MIS plaque scoring system on photos had good reliability within and between trials following protocol training and calibration. OHI-MIS provides a novel asynchronous plaque scoring system for use in young children. Non-clinicians in field or clinical settings can obtain photographs, offering new opportunities for research and clinical care.

Objective Photoanalysis of Feminizing Frontal Cranioplasty Outcomes.

Retrospective analysis at a tertiary care center. This study describes a method of analyzing postoperative results using lateral view clinical photographs to create normalized projection ratios of the glabella and radix. We reviewed preoperative and postoperative photographs of 15 patients. All photographs were in the lateral view Frankfort horizontal plane. We calculated the distances between the (a) tragus and cornea, (b) cornea and radix, (c) cornea and glabella, and the (θ) nasofrontal angle. Fifteen sets of patient photographs were analyzed and found that there was a favorable 14% reduction at the radix and an even greater reduction (78.9%) at the glabella. The nasofrontal angle was improved to a more feminine range from 131.84° preoperatively to 145.86° postoperatively. Normalized projection ratios of the glabella and radix, along with the nasofrontal angle, can be used to objectively measure outcomes of frontal feminizing cranioplasty.

Detection of oral squamous cell carcinoma in clinical photographs using a vision transformer

Oral squamous cell carcinoma (OSCC) is amongst the most common malignancies, with an estimated incidence of 377,000 and 177,000 deaths worldwide. The interval between the onset of symptoms and the start of adequate treatment is directly related to tumor stage and 5-year-survival rates of patients. Early detection is therefore crucial for efficient cancer therapy. This study aims to detect OSCC on clinical photographs (CP) automatically. 1406 CP(s) were manually annotated and labeled as a reference. A deep-learning approach based on Swin-Transformer was trained and validated on 1265 CP(s). Subsequently, the trained algorithm was applied to a test set consisting of 141 CP(s). The classification accuracy and the area-under-the-curve (AUC) were calculated. The proposed method achieved a classification accuracy of 0.986 and an AUC of 0.99 for classifying OSCC on clinical photographs. Deep learning-based assistance of clinicians may raise the rate of early detection of oral cancer and hence the survival rate and quality of life of patients.

The Study of a Validated Assessment Scale for a Localized Submental Fat Volume.

This aim of this study was to develop an objective tool for rating submental fat applied to Koreans. The study was conducted between April 2019 and October 2019. A total of 92 subjects were enrolled in the study. Clinical photos of the subjects were categorized using validated CR-SMFRS by three plastic surgeons and one dermatologist. The categorized photos were then shown to six different plastic surgeons for evaluation. The Cohen's kappa value for the six raters were 0.830, 0.742, 0.703, 0.907, 0.862, and 0.793 with statistical significance (p < 0.001). ICC value was between 0.860 and 0.966 (p < 0.001). Since the Cohen's value and ICC were above 0.6 for all raters, the ratings performed by all six raters were used in the analysis. The ICC values between raters were between 0.899 and 0.902. We came up with a set of reference photos that can be used for submental fat rating scale applicable to Korean subjects. II.

Multimodal deep learning of fundus abnormalities and traditional risk factors for cardiovascular risk prediction

Cardiovascular disease (CVD), the leading cause of death globally, is associated with complicated underlying risk factors. We develop an artificial intelligence model to identify CVD using multimodal data, including clinical risk factors and fundus photographs from the Samsung Medical Center (SMC) for development and internal validation and from the UK Biobank for external validation. The multimodal model achieves an area under the receiver operating characteristic curve (AUROC) of 0.781 (95% confidence interval [CI] 0.766–0.798) in the SMC and 0.872 (95% CI 0.857–0.886) in the UK Biobank. We further observe a significant association between the incidence of CVD and the predicted risk from at-risk patients in the UK Biobank (hazard ratio [HR] 6.28, 95% CI 4.72–8.34). We visualize the importance of individual features in photography and traditional risk factors. The results highlight that non-invasive fundus photography can be a possible predictive marker for CVD.

A pilot study comparing optical coherence tomography, radiography, clinical photography, and polarisation microscopy for studies of hypomineralisation disturbances in enamel

AimTo investigate the use of optical coherence tomography (OCT) as a tool to assess general and localised hypomineralisation defects in the enamel. Design and MaterialsTen extracted permanent teeth (four teeth with localised hypomineralisation, four teeth with general hypomineralisation, and two healthy controls) were used in this study. In addition, four participants who underwent OCT served as living controls for the extracted teeth. MethodsThe OCT results were compared with clinical photographs, digital radiographs, and polarising microscopy images of tooth sections (considered the gold standard) to determine the method with the most accurate information regarding the extent of enamel disturbances: 1) visibility of enamel disturbance (visible yes/no); if yes, 2) extent of the disturbance in the enamel; and 3) determination of the plausible involvement of the underlying dentin. ResultsOCT was more accurate than digital radiography and visual assessment. OCT could provide information about the extent of localised hypomineralised disturbances in the enamel that was comparable to that with polarisation microscopy of the tooth sections. ConclusionWithin the limitations of this pilot study, it can be concluded that OCT is suitable for investigating and evaluating localised hypomineralisation disturbances; however, it is less useful in cases with generalised hypomineralisation of the enamel. In addition, OCT complements radiographic examination of enamel; however, more studies are necessary to elucidate the full extent of the use of OCT in case of hypomineralisation.

The Role of Machine Learning and Deep Learning Approaches for the Detection of Skin Cancer.

Machine learning (ML) can enhance a dermatologist's work, from diagnosis to customized care. The development of ML algorithms in dermatology has been supported lately regarding links to digital data processing (e.g., electronic medical records, Image Archives, omics), quicker computing and cheaper data storage. This article describes the fundamentals of ML-based implementations, as well as future limits and concerns for the production of skin cancer detection and classification systems. We also explored five fields of dermatology using deep learning applications: (1) the classification of diseases by clinical photos, (2) der moto pathology visual classification of cancer, and (3) the measurement of skin diseases by smartphone applications and personal tracking systems. This analysis aims to provide dermatologists with a guide that helps demystify the basics of ML and its different applications to identify their possible challenges correctly. This paper surveyed studies on skin cancer detection using deep learning to assess the features and advantages of other techniques. Moreover, this paper also defined the basic requirements for creating a skin cancer detection application, which revolves around two main issues: the full segmentation image and the tracking of the lesion on the skin using deep learning. Most of the techniques found in this survey address these two problems. Some of the methods also categorize the type of cancer too.

Symblepharon in kittens: a retrospective study of 40 kittens and 54 eyes (2002-2022).

The aim of this study was to retrospectively evaluate the signalment, treatment, surgical technique and outcomes for feline symblepharon. A retrospective medical record review and standardized grading of clinical descriptions and photographs was undertaken. Forty kittens (54 eyes) aged 3-46 weeks had symblepharon of five types in various combinations: eyelid deformation (24 kittens; 32 eyes); ankyloblepharon (four kittens; four eyes); conjunctiva-to-conjunctiva (11 kittens; 12 eyes); third eyelid-to-conjunctiva (24 kittens; 29 eyes); and corneoconjunctival adhesions (14 kittens; 16 eyes). At initial presentation, 23 (43%) eyes were affected by one type of symblepharon, 25 (46%) eyes by two types and six (11%) eyes by three types; 11 (20%) corneas were ulcerated. Twenty-four (44%) eyes of 18 (45%) kittens were managed medically. Surgery was performed under general anesthesia/sedation (30 occasions) or topical anesthesia (21 occasions) on 30 (56%) eyes of 22 kittens; 12 eyes (40%) underwent multiple surgeries. Four techniques were commonly employed: separation of conjunctival-to-conjunctival adhesions ± eyelid margins (14 eyes); resection of third eyelid adhesions ± temporary tacking of the third eyelid (modified Arlt's pterygium technique; 18 eyes); en bloc resection of the third eyelid (two eyes); and separation of corneoconjunctival adhesions (14 eyes). Median duration of follow-up was 55 days (range 1-1051). Median symblepharon grade in kittens treated surgically improved for all types except corneoconjunctival symblepharon. Median symblepharon grade in kittens receiving medical management remained the same or improved. Corneoconjunctival symblepharon opacity decreased for eyes treated surgically but increased for eyes treated medically. Three eyes were enucleated due to complications of corneoconjunctival symblepharon. At final presentation, symblepharon persisted in 46 (85%) eyes; however, menace response was evident in 13/16 eyes and dazzle reflex in 23/23 eyes. Symblepharon is a heterogeneous group of conditions with diverse anatomic involvement, clinical appearance and impact, optimal treatment and prognosis for vision.

Mussel adhesive protein treatment delivered by microneedling for sensitive skin: A clinical study.

Mussel adhesive protein (MAP) is extracted from the mycelial glands of marine mussels. It has anti-inflammatory properties and may relieve skin itching and other symptoms. Based on the anti-inflammatory effect of MAP, this study was designed to treat sensitive skin (SS) using MAP delivered by skin microneedling. Twenty-three Chinese female patients with SS were enrolled. Treatments were delivered three times at one-month intervals. Symptom improvement and recurrence rates, treatment safety, and patient satisfaction levels were evaluated. After one course of treatment, 20 patients had a Symptom Score Reducing Index (SSRI) of >20%, with an effectiveness rate of 87%. At the end of treatment, all patients had an SSRI of >20%, and the effectiveness rate was 100%. Dryness, tightness, desquamation, flushing, burning, itching, and tingling improved. After treatment, the Clinical Erythema Assessment and Lesion Severity Index of Facial Telangiectasia scores were significantly decreased. Clinical photographs following treatment revealed improved erythema reaction and decreased capillary density. During treatment, the patients experienced mild pain and erythema and swelling reaction without exudation. Complications, such as pigmentation changes or scarring, were absent. Additionally, there were no cases of recurrence, and patient satisfaction levels were high. MAP combined with microneedling can help treat SS, showing satisfactory safety outcomes and high patient satisfaction.

Clinical images, imperial power and Bhau Daji&amp;rsquo;s secret treatment for leprosy at the Royal College of Physicians Museum

In 1874, Indian polymath physician Bhau Daji (1822–1874) passed away suddenly – and the details of his secretive ‘cure’ for leprosy died with him. Drawing on a collection of clinical photographs and illustrations at the Royal College of Physicians (RCP) Museum, this paper will unravel Daji’s place in the College’s empire-wide enquiry into leprosy in the mid-nineteenth century. We will argue, drawing on Elizabeth Edward’s (2014) work, that these images represent ‘photographic uncertainties’ – both conforming to and undermining traditional conventions of colonial photography, while at the same time highlighting Daji’s place as an ambiguous figure in colonial medical hierarchies. We treat the images as ‘visual arguments’ (Fox and Lawrence, 1998) testifying to the effectiveness of Daji’s secret remedy and the contagious nature of the disease. Despite the supposed objectivity of the photographic form, Daji’s treatment was never seriously investigated by the Leprosy Committee of the Royal College of Physicians. Transported from Bombay to London, we will consider the differential value placed on Daji’s medical expertise as captured by the patient images. In the spirit of the current movement to ‘decolonise collections’, we reflect on how this case study demonstrates the need for specialist medical museums to interrogate their own colonial pasts.

Artificial Intelligence-Based Diagnosis of Oral Lichen Planus Using Deep Convolutional Neural Networks.

The aim of this study was to employ artificial intelligence (AI) via convolutional neural network (CNN) for the separation of oral lichen planus (OLP) and non-OLP in biopsy-proven clinical cases of OLP and non-OLP. Data comprised of clinical photographs of 609 OLP and 480 non-OLP which diagnosis has been confirmed histopathologically. Fifty-five photographs from the OLP and non-OLP groups were randomly selected for use as the test dataset, while the remaining were used as training and validation datasets. Data augmentation was performed on the training dataset to increase the number and variation of photographs. Performance metrics for the CNN model performance included accuracy, positive predictive value, negative predictive value, sensitivity, specificity, and F1-score. Gradient-weighted class activation mapping was also used to visualize the important regions associated with discriminative clinical features on which the model relies. All the selected CNN models were able to diagnose OLP and non-OLP lesions using photographs. The performance of the Xception model was significantly higher than that of the other models in terms of overall accuracy and F1-score. Our demonstration shows that CNN models can achieve an accuracy of 82 to 88%. Xception model performed the best in terms of both accuracy and F1-score.

Diverse approaches to the diagnosis and treatment of paediatric vitiligo: a survey of paediatric dermatologists

Abstract There is a paucity of research concerning the diagnosis and treatment of paediatric vitiligo. This reality parallels published patient reports of profound dissatisfaction with the state of knowledge and available treatments. This study was meant to assess the attitudes of paediatric dermatologists towards the therapeutics of paediatric vitiligo. A survey was designed and approved by the survey committee of the Pediatric Dermatology Research Alliance to be distributed to the members. The study was exempted by the IRB of the Mount Sinai Hospital and posted to an online survey system. A total of 56 dermatologists completed the survey, a majority of whom practiced in the US (n = 44, 78·6%), followed by Mexico (n = 6, 10·7%). Most were board-certified (n = 48, 85·7%). Practitioners reported seeing an average of eight paediatric and adolescent vitiligo patients per month. Providers surveyed reported feeling most comfortable treating older patients 13–17 (n = 48, 85·7%), 9–12 (n = 47, 84%), 5–8 (n = 40, 71·4%), 2–4 years (n = 18, 32·1%), 13–23 months (n = 12, 21·4%), 7–12 months (n = 4, 7·1%), and 0–6 months (n = 1, 1·7%). Among the 8 (14·3%) respondents who used an oral JAK inhibitor, the age of the patients ranged from 4 months to 16 years. Most providers surveyed (n = 50, 89·3%) used an interview with the patient and parents to assess for quality-of-life impairments in children and adolescents. Bloodwork was performed always or usually (n = 25, 44·6%), sometimes (n = 11, 19·6%), and rarely (n = 9, 16·1%). Full thyroid panels (n = 38, 67·8%) and 25-OH vitamin D levels (n = 27, 48·2%) led tests ordered. For children under 8 years with &amp;lt;25% +/− eyelid localization TCI (n = 52, 92·9%; n = 46, 82%), TCS (n = 17, 30·3%; n = 29, 51·7%), Narrow band UVB (NB-UVB, n = 11, 19·6%; n = 5, 8·9%), topical JAK inhibitors (tJAK-i) (n = 6, 10·2%, n = 5, 8·9%), cover-up makeup (n = 7, 11·9%; n = 6, 10·7%), and excimer laser (n = 5, 8·5%; n = 9, 16·1%) were prescribed. For &amp;lt;8 with &amp;gt;25% vitiligo +/− eyelid involvement TCI (n = 48, 85·7%; n = 45, 80·3%), TCS (n = 21, 37·5%; n = 30, 53·6%), excimer laser (n = 8, 85·7%; n = 11, 19·6%), NB-UVB (n = 6, 10·7%; n = 7, 12·5%), and cover-up makeup (n = 7, 11·9%; n = 8, 14·3%) were used. For 8+ with body depigmentation &amp;lt;25% or 25%+, TCI (n = 29, 51·8%, n = 22, 39·3%), TCS Class 1 (n = 24, 42·8%), and NB-UVB (n = 17, 30·4%; n = 31, 55·4%), oral steroids (n = 10, 17·9%; n = 12, 21·4%), tJAK-i (n = 5, 8·9%; n = 16, 28·6%); TCS (n = 13, 23·2%), NB-UVB/home phototherapy units (n = 8, 14·3%; n = 22, 39·2%), oral methotrexate (25%+ only; n = 10, 17·9%), TCS (n = 9, 16·1%), and Class 3 TCS (n = 5, 8·9%). Paediatric segmental vitiligo localized to the face was predominantly treated by TCI (n = 46, 82·1%), excimer laser (n = 14, 25%), and occasional tJAKi (n = 8, 14·3%). Treatments identified for segmental vitiligo of the body included TCS (n = 48, 85·7%), TCI (n = 24, 42·9%), NB-UVB (n = 15, 26·8%), and tJAKi (n = 5, 8·9%). Methodologies for assessing vitiligo improvement were clinical photographs, measurement of lesion size (n = 48 each, 85·7%), subjective patient-reported satisfaction (n = 41, 73·2%) and percent re-pigmentation (n = 34, 60·7%). A total of 94·6% reported occasional to constant frustration due to a lack of treatment options and insurance barriers and always or often experiencing challenges in procuring appropriate therapies for patients, including tJAKi and TCI. Parental phobia of topical corticosteroid in paediatric patients was noted at least occasionally (n = 29, 51·8%) to regularly (n = 10, 17·8%). Topical calcineurin inhibitors are favoured for the youngest patients as well as for segmental vitiligo. Topical steroids and UVB light sources are used for older children with more extensive and body disease. The diverse treatment modalities represented underscore the need for a systemized approach to this disease. Even paediatric dermatologists are uncomfortable with infants and small children with vitiligo and more data are needed for guidance in all children, especially infants and toddlers.

The peri-implant mucosa color: A systematic appraisal of methods for its assessment and clinical significance.

Peri-implant mucosa color (PMC) seems to be one of the main parameters affecting the esthetic outcome of implant therapy. However, more emphasis should be given to its assessment and reporting. To describe the available evidence on methods to assess and report the color of the peri-implant mucosa (PMC) and the respective clinical relevance. A comprehensive electronic and manual search was performed to identify clinical studies reporting on PMC. A total of 121 studies were included. PMC was evaluated at the time of the follow-up visit (chairside) in 45.5% studies. PMC assessment was performed qualitatively, by comparing PMC with adjacent and/or contralateral gingiva (78.6%) or quantitatively, using spectrophotometry (20.7%) or a software on clinical photographs (0.8%). The most performed method to assess PMC was through esthetic indices (76.9%), either at the time of the follow-up visit (chairside) or at later time point using photographs. Quantitative reporting of PMC included averages of points from esthetic indices or color differences to natural gingiva expressed with the CIELAB color system. PMC assessment allowed describing color discrepancies compared to natural gingiva, evaluating color changes over time, and comparing the outcomes of different treatment modalities. PMC assessment through spectrophotometry was additionally utilized to assess the role of mucosal thickness (MT) on PMC. Various methods for PMC assessment and reporting were described, including visual assessment, mainly through esthetic indices, and spectrophotometry. PMC evaluation has allowed to demonstrate the factors affecting the color of the peri-implant soft tissue, such as the type of abutment/restoration, MT, and soft tissue augmentation.

Poly Lactic-co-Glycolic Acid Absorbable Plate Graft for Secondary Rhinoplasty in Asian Patients with Unilateral Cleft Lip Nose Deformity.

In secondary cleft lip and nasal deformity (CLND) correction, structural grafts are commonly used to control the nasal tip and restore the symmetry of the ala. However, the septal cartilage in Asians often weak and small. Biocompatible absorbable materials are alternatives to autologous grafts. This study assessed the surgical outcomes and complications of poly lactic-co-glycolic acid (PLGA) plate grafts in secondary CLND correction. This study was retrospectively analyzed for patients who underwent secondary rhinoplasty for unilateral CLND correction between March 2015 and November 2020. Using open rhinoplasty, the PLGA plate was grafted as a columellar strut. Clinical photographs taken at the initial (T0) and follow-up visits (T1: short-term, T2: long-term) were analyzed and anthropometric parameters, such as nostril height and width, dome height, and tip height, were measured. Twenty-four patients were included in this study. The mean T1 and T2 periods were 1.0 ± 0.4 and 15.5 ± 3.1 months, respectively. The nostril height ratio increased from 0.78 ± 0.12 at T0 to 0.88 ± 0.08 at T1 and 0.86 ± 0.09 at T2 (p < 0.001; Relapse ratio -2.6 ± 6.7%). The tip height ratio increased from 0.60 ± 0.07 (T0) to 0.66 ± 0.05 (T2) (Relapse ratio -3.7 ± 3.0%). The PLGA plate graft provided stable nasal tip projection and alar symmetry without major complications. It can be a good option for patients lacking available septal and concha cartilages or apprehensive of additional scarring.

Dynamic ultrasound assessment of hip instability and anterior and posterior hip impingement.

In this technical report, we describe our protocol for the dynamic sonographic evaluation of the hip and assess reliability of the ultrasound assessment of hip microinstability. Our clinical experience with a standardized dynamic ultrasound of the hip performed in a series of 27 patients with imaging performed by an experienced musculoskeletal radiologist during physical examination by an orthopedic surgeon specializing in hip preservation is illustrated with clinical photographs and ultrasound images from volunteers and selected patients. Interrater reliability for the diagnosis of microinstability was calculated. Dynamic ultrasound technique and findings of hip instability, femoroacetabular impingement, and ischiofemoral impingement with corresponding clinical photos showing the necessary physical examination maneuvers are described. Interrater agreement for the diagnosis of microinstability was substantial (κ 0.606 [0.221-0.991]). At our institution, dynamic ultrasound of the hip during physical examination complements information gathered from static imaging by providing real-time correlation of symptoms with what is occurring anatomically.

Successful Management of an Acute Case of Orbital Cellulitis of Odontogenic Origin.

Sir, Dental infections left untreated can progress through tissue planes into the orbital space through sinuses and result in orbital abscess which is an ophthalmic emergency. We describe the case of a 47-year-old female, a known diabetic who presented with complaints of severe swelling and pain in periorbital region, associated with fever, vomiting, and prostration for 20 days’ duration. She gave a history of repeated episodes of dental pain arising out of her impacted upper third molar tooth for the past 2 months. Ocular examination of the right eye showed significant proptosis of 24 mm, restriction of extraocular movements in all directions, normal pupillary reaction with best-corrected visual acuity of 6/24, and intraocular pressure of 21 mm of Hg [Figure 1a]. Magnetic resonance imaging (MRI) showed heterogeneous multifocal lesions in the right orbit with T1 hypointensity, T2 hyperintensities with internal septation in the intra-conal and extraconal compartments producing compression over the globe [Figure 1b]. Dental X-ray was suggestive of impacted right maxillary third molar tooth [Figure 1c]. On the second day of her hospital stay, she developed multiple upper and lower eyelid pre-septal and post-septal abscesses which were drained, and the pus was sent for culture and sensitivity. Systemic antibiotics were started in the form of intravenous piperacillin/tazobactam (4.0/0.5 g) 8 hourly, metronidazole (500 mg/100 ml) 8 hourly, and oral linezolid (600 mg) 12 hourly. Blood sugars were monitored and insulin was administered as per her requirement. She was referred to dental surgeon for extraction of the impacted molar tooth. She recovered completely with best-corrected visual acuity of 6/9 and intraocular pressure of 16 mm of Hg. She showed remarkable improvement at 2 weeks after tooth extraction [Figure 1d].Figure 1: (a) Clinical photograph at presentation showing severe proptosis, complete ptosis, erythema, restricted extraocular movements, and pus pointing over lower eyelid skin. (b) MRI sagittal section T1 image showing multiloculated abscesses in intraconal and extraconal compartment of right orbit causing compression of eyeball. (c) Right maxillary posterior intraoral periapical radiograph showing impacted upper third molar tooth. (d) Clinical photograph of the same patient after two weeks with complete resolution of edema, proptosis, and extraocular movements. MRI: Magnetic resonance imagingOrbital cellulitis secondary to dental infection is rare accounting for 2%-5% of all cases of orbital infections.[1] To add to its rarity, orbital abscess constitutes less than 1.3% of abscesses seen in maxillofacial region.[2] Surgical drainage of the abscess and pus sample collection is a recommended modality of treatment as reported by many authors.[3,4] Empirical antibiotics and proper intravenous fluid hydration are mainstay of treatment. Systemic corticosteroids fasten the resolution of inflammation and duration of hospital stay.[5] A multidisciplinary approach with dentists, diabetologists, and ophthalmologists is required to prevent serious complications of venous sinus thrombosis. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed. Research quality and ethics statement The authors followed applicable EQUATOR Network (http://www.equator-network.org/) guidelines, notably the CARE guideline, during the conduct of this report. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Management of stenosing flexor tenosynovitis in primary care.

Management of stenosing flexor tenosynovitis in primary care.

The Safety and Efficacy of Macrofocused Ultrasound without Visualization on Enlarged Facial Pores among Thai Patients: A Pilot Study

Introduction. Visibly enlarged facial pores are familiar dermatologic concerns. Macrofocused ultrasound energy without visualization (MaFU‐WV) showed efficacy in facial tightening and an improvement in skin textural irregularities which opened the potential of the positive effects in reducing the appearance of facial pores. This study aims to assess the safety and efficacy of MaFU‐WV in tightening facial pores. Methods. This was a prospective, single‐blinded pilot study. Thirty‐four Thai subjects with enlarged pores received a single treatment of MaFU‐WV using a 2.0 mm transducer on bilateral malar areas of the face. Primary outcome measures included the pore count, pore volume, and pore index measurements using an instrument with a camera for image acquisition and software for analysis of skin. Secondary outcome measures incorporated two blinded dermatologists’ evaluation of clinical photographs and the subjects’ perception of improvement in their facial pores using a 6‐point scale. Measurements were taken at baseline, 1 week, 1 month, 3 month, and 6 month after treatment. Results. The pore count significantly decreased from baseline to 6 month after treatment (p &lt; 0.001). Pore volume was significantly lowered from baseline to 1 week and 1, 3, and 6 months after treatment (p &lt; 0.05). The pore index was likewise significantly reduced from baseline in every visit (p &lt; 0.05). The majority of photographic evaluations by blinded dermatologists were scored as a 1–25% pore minimizing effect across nearly all follow‐up visits. On the other hand, patient satisfaction kept improving until the end of the study at 6 months. No adverse events occurred throughout the conduct of the study. Conclusion. Macrofocused ultrasound energy using a 2 mm transducer is a safe and effective treatment for facial pore tightening. The trial is registered with registration number: TCTR20220719001.

Optimizing Management of Asymmetric Ptosis: A Comparison of Three Posterior Approach Resection Algorithms.

The purpose of this study was to compare the efficacy of 3 resection algorithms in the management of patients with asymmetric ptosis. Patients undergoing bilateral Muller's muscle-conjunctival resection (MMCR) were identified. Standardized preoperative clinical photographs were examined and margin reflex distance 1 (MRD1) was measured using ImageJ. Patients presenting with ≥1 mm of asymmetry in MRD1 were included. Three groups were identified: variable (4:1 ratio, with the lower side receiving a greater resection), fixed (7 mm resection bilaterally), and tarsectomy (7 mm bilaterally + 1 mm of tarsus resected on the lower preoperative side). Postoperative MRD1 was measured from photographs obtained 3 months after surgery. The primary outcome was postoperative asymmetry. A total of 95 patients with a mean age of 71.0 ± 11.0 years were included. There was no significant difference in age ( p = 0.277) or length of follow-up ( p = 0.782) between the groups. Although the fixed tarsectomy group had significantly greater preoperative asymmetry ( p = 0.001), there was no significant difference in postoperative asymmetry ( p = 0.166). On multivariate analysis, preoperative asymmetry was the only significant predictor of postoperative asymmetry ( p < 0.001). Specifically, the surgical group was not a predictor of the primary outcome ( p = 0.723). Resection amount and technique did not predict postoperative outcomes in cases of asymmetric ptosis. This may support the hypothesis that changes in eyelid position and symmetry following MMCR is due to a dynamic system, rather than as a result of purely mechanical forces.

Moderna Arm Cutaneous Side Effect of Moderna Vaccine among Healthcare Providers in Secondary Hospital in Jakarta - Tangerang, Indonesia.

Introduction: Since the emerging Delta variant of COVID-19 in 2021, the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) have encouraged world citizens to get booster vaccination. Booster vaccination has been used worldwide to prevent severe COVID-19. Healthcare providers were given the priority to be vaccinated, and the Moderna vaccine was given as chosen booster vaccination. Cutaneous side effect related to the Moderna vaccine has been reported in Public Secondary Hospital in both two cities in Indonesia, Jakarta and Tangerang. Material &amp; Methods: The observation for this report took place from August until September 2021. All the patients gave their informed consent to participate in this case report and explicit consent to use their clinical photos. We collected data on 357 cases for 2 months in Dr. Suyoto Hospital (Jakarta) dan Dr. Sitanala Hospital (Tangerang). Results: The total number of healthcare workers who got the booster vaccine was 1370, and the number of experienced Moderna Arm was 350 cases: 321 cases with edema, urtica, and erythematous rash, and 29 cases with ecchymosis in Suyoto Hospital while in Sitanala Hospital 7 cases of urtica &amp; erythematous rash. Conclusion: There were side effects after the Moderna injection, and it was important to inform the recipient about those effects.