Types Of Lesions Research Articles

Lupus nephritis and related renal disease: review from case series.

Renal lesions due to systemic lupus erythematosus (SLE) are defined as lupus nephritis (LN), a renal disease characterized by the deposition of immunoglobulin (Ig)G-based immune complexes in the kidney and the appearance of double-stranded DNA and Smith antibodies. In particular, deposition of IgG3, which has strong complement binding properties, under the endothelium or in the mesangium activates the classical complement pathway of C1q, C4, and C3, leading to renal damage. This step is followed by migration of inflammatory cells, including neutrophils and monocytes, which induce inflammation in the glomerular capillaries and cause mesangiolysis and endothelial cell damage, resulting in endocapillary proliferative nephritis. LN is classified as class I to IV depending on the degree of inflammation or as class V in cases of subepithelial deposition of immune complexes in glomeruli. Deposition in the renal small arterioles by the same mechanism induces thrombus formation, resulting in lupus vasculopathy. Deposition in the tubular basement membrane and peritubular capillaries leads to tubulointerstitial lupus nephropathy. The appearance of antiphospholipid antibodies leads to acute and chronic forms of antiphospholipid antibody nephropathy (APSN) due to thrombus formation. This article reviews cases of the typical diverse renal lesions in LN.

The complexity of the interpretation of ELISA and RT-PCR results in the diagnosis of a reticuloendotheliosis virus infection: an extended case study.

Reticuloendotheliosis virus (REV) is a species of the genus Gammaretrovirus that can cause neoplasia, immunosuppression, and runting-stunting syndrome. To show the clinical relevance of REV is complicated, and requires the demonstration of the virus, REV antibodies, the presence of typical gross and microscopic lesions, and the exclusion of other oncogenic agents in the case of the presence of tumours. Under field conditions, the first tests to be used might be a commercially available REV antibody ELISA or an RT-PCR to detect the REV genome. In this short paper, we present the experiences with two commercially available ELISAs and RT-PCR that we have gained from a REV outbreak on a large multi-age layer farm and many follow-up tests on samples from control farms with and without a known history of REV and fowlpox virus (FPV). In the field, some of the FPV field strains contain large inserts of the REV genome that might interfere with REV testing. The results of the ELISAs on sera from REV- and FPV- unsuspected flocks suggested that the cut-offs of both ELISAs were somewhat low resulting in a lower specificity. However, cut-offs of 2000 and 3050 for the IDEXX and BioChek ELISAs, respectively, gave an agreement of 100%, suggesting that these cut-offs might be advisable to use. The use of the combination of RT-PCR for REV and PCR for FPV proved to be very useful in separating REV infections from FPV infections. The results of our extended field study can help to interpret REV testing results.

Endometrial Intraepithelial Neoplasia, Concurrent Endometrial Cancer and Risk for Pelvic Sentinel Node Metastases

Background/objectives: Given the risk of a progression, or an undiagnosed endometrial cancer (EC), the treatment of choice is hysterectomy in women with endometrial intraepithelial neoplasia (EIN). The risk of metastatic disease and whether sentinel node (SLN) biopsy should be performed remains unclear. The primary aim of this prospective study was to determine the overall incidence of concurrent EC and the impact of the diagnostic tool used and the type of endometrial lesion. The secondary aim was to investigate the risk of metastatic SLNs. Methods: Between July 2019 and May 2024, 98 consecutive women with EIN deemed suitable for robotic surgery and SLN dissection were included in the study. Ultrastaging and immunohistochemistry were performed on all SLNs. Results: In total, 47% of women with preoperative EIN had EC on final histology; 13% of these had metastatic SLNs and the overall risk of metastases was 6.3%. Women who obtained their diagnosis by an endometrial biopsy had 65% risk of EC. All women with metastatic SLNs had non-polypoid lesions and five out of six obtained their diagnosis through endometrial biopsy. Conclusions: The overall risk of SLN metastases was 6.3%, all in women with a general endometrial thickening and/or a diagnosis of EIN by office endometrial biopsy, suggesting that SLN detection should be offered particularly to women with EIN who fulfill these preoperative criteria.

Upgrade Rate of Exclusively MRI-Detected Papillomas in Asymptomatic Patients Undergoing Screening or Extent of Disease Examinations.

To determine the upgrade rate of exclusively MRI-detected benign papillomas in asymptomatic high-risk patients, patients with a history of cancer, or patients with known malignancy. This IRB-approved retrospective study reviewed all breast MRI-guided biopsies yielding papilloma on pathology for all asymptomatic patients undergoing breast MRI for high-risk screening, newly diagnosed breast cancer, or a personal history of breast cancer. All cases were followed by excision or 2-year imaging follow-up. The upgrade rate was determined. Fisher's exact test was used to determine the significance of associated factors, including lesion type, lesion size, and ipsilateral malignancy. Of the 258 MRI-guided biopsies, 117 met the inclusion criteria. A 4% (5/117) upgrade rate was found with a 3% (4/117) upgrade rate to ductal carcinoma in situ (DCIS) and a 1% (1/117) upgrade rate to invasive malignancy for all identified papillomas. When evaluating all papillomas, the only associated feature identified to be statically significant for risk of upgrade was ipsilateral malignancy with a 60% (3/5) upgrade rate with a P-value of .0057. When separately evaluating benign papillomas only by excluding those with atypia or additional high-risk lesion at biopsy, a 4% (3/80) upgrade rate to DCIS was found. There was no upgrade to invasive malignancy. Upgrade of MRI-detected papillomas in asymptomatic high-risk patients, patients with a history of cancer, or patients with known malignancy is 4% in this population, which suggests these lesions may warrant surgical excision.

Management of endometriosis: a call to multidisciplinary approach.

Endometriosis is defined as the presence of endometrial-like glands and stroma outside of the uterus. There are three types of endometriotic lesions: superficial or peritoneal endometriosis, ovarian endometrioma, and deep infiltrating disease. Endometriosis not only occurs in the pelvis but also can be found in extrapelvic sites such as the gastrointestinal tract, upper abdominal viscera, genitourinary tract, abdominal wall, diaphragm, and thoracic cavity. After thorough history and physical examination is performed, imaging, such as ultrasound or magnetic resonance imaging (MRI), should be obtained if there is high suspicion for deep-infiltrating endometriosis to better assess visceral involvement. Endometriosis can be suspected based on symptoms, physical examination findings, and imaging. However, a definitive diagnosis requires histopathologic confirmation. Treatment options include expectant, medical, and surgical management. Endometriosis is largely a quality-of-life issue, and treatment should be tailored accordingly with empiric medical therapy frequently utilized. Medical management focuses on symptom improvement. Surgical management with excision of endometriosis is preferred over ablation or fulguration of endometriotic lesions. In the case of deep or extrapelvic endometriosis, treatment with a multidisciplinary team with experience in the treatment of advanced-stage endometriosis is essential to minimizing morbidity and increasing long-term success.

Reporting Bone Cytopathology-A Proposal Based on a Single Tertiary Centre Experience.

Fine-needle aspiration cytology (FNAC) from bone lesions has been proven to be a useful diagnostic tool but lacks standardisation. The aim of the study was to evaluate the diagnostic utility of FNAC as a basis to propose and test a reporting system for bone reporting cytopathology. This retrospective study is based on patients with bone lesions, that were approached by cytology at Skåne University Hospital, Sweden between 2015 and 2023. The diagnostic performance was measured by sensitivity, specificity and accuracy analyses. All diagnoses were then distributed in six categories: (I) Non-diagnostic, (II) Benign, (III) Atypia, (IV) Bone neoplasm of uncertain significance, (V) Suspicious for malignancy and (VI) Malignant. The risk of malignancy (ROM) in each category was calculated. The final cohort consisted of 721 cases. Bone cytology was able to differentiate between benign and malignant lesion with a sensitivity of 89% and a specificity of 99%. The overall diagnostic accuracy was 65% but varied significantly among different types of lesions. Within the tested diagnostic categories, the ROM was (I) 48%, (II) 6.7%, (III) 69%, (IV) 28%, (V) 93% and (VI) 100%. FNAC from bone lesions is a sensitive and specific diagnostic tool with high diagnostic accuracy among various tumour types. This study provides valuable insights for the development of a standardised reporting system for bone cytopathology.

EVALUATION OF EFFICACY AND SAFETY OF AZITHROMYCIN AND DOXYCYCLINE IN TREATMENT OF ACNE VULGARIS WITH DIFFERENT LEVELS OF SERUM TESTOSTERONE: A PROSPECTIVE, RANDOMIZED, CONTROLLED, COST-EFFECTIVE, COMPARATIVE STUDY

Objectives: The objectives of this study are to compare the therapeutic efficacy, safety, quality of life (QoL), and cost-effectiveness of azithromycin and doxycycline in patients with acne vulgaris and the correlation of serum testosterone levels with the severity of acne. Methods: A prospective, randomized, open-label study was conducted at a tertiary care hospital in South India, according to the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use Guideline for Good Clinical Practice principles. After institutional ethics committee approval, 100 patients aged 15–40 with moderate-to-severe acne were enrolled, excluding those with a history of gastritis, drug hypersensitivity, pregnancy, or under 12 years old. Participants were randomized to receive either oral azithromycin 500 mg daily for three consecutive days each week for 4 weeks, or doxycycline 100 mg daily for 28 days, along with topical treatments. Efficacy was measured by the type and number of acne lesions, graded according to standardized criteria. QoL was assessed using the Cardiff Acne Disability Index (CADI). Serum testosterone levels were correlated with acne severity. Results: Of the 96 patients (42 males, 54 females) who completed the study, 49 were in the azithromycin group and 47 in the doxycycline group. The mean age was 23.5 years in the azithromycin group and 22.1 years in the doxycycline group. Significant reductions in acne severity and number of lesions were observed in both groups (p<0.0001), with azithromycin showing superior improvement (p<0.01). At baseline, most patients had Grade 3 or 4 acne, which improved significantly post-treatment. QoL improvements were also significant in both groups, with mean CADI scores reducing from around 8 to below 4 (p<0.0001). A weak positive correlation (r=0.24) was found between serum testosterone levels and acne severity. Adverse events were mild and did not necessitate discontinuation. To achieve a 1 unit decrease in CADI, azithromycin treatment costed an additional rupees of 264.5 over doxycycline. Conclusion: Azithromycin and doxycycline are effective treatments for moderate-to-severe acne vulgaris, with significant improvements in clinical and QoL outcomes. While azithromycin offers better clinical efficacy, doxycycline provides a more cost-effective option. Further studies could explore long-term outcomes and the impact of hormonal variations on treatment efficacy.

Skin Disease Detection Using Ensemble Learning

Skin diseases affect millions of people worldwide, making early detection and accurate diagnosis crucial for effective treatment. However, the process of diagnosing skin conditions often requires specialized dermatological expertise, which can be time-consuming and expensive. To address this challenge, we have developed a web-based Skin Disease Detection System using cutting-edge machine learning and ensemble techniques. Our system leverages the HAM10000 dataset, consisting of 10,000 dermoscopic images representing seven common skin lesion types. We employ an ensemble learning approach, integrating ResNet50, EfficientNetB0, and DenseNet121 as base models and combining their predictions using a logistic regression meta-model. This architecture enhances the accuracy and robustness of the predictions. The backend of our application is built with Flask, responsible for model processing, authentication, and handling API requests. The React frontend provides an intuitive user interface where users can upload skin lesion images and receive real-time predictions along with confidence scores. The system also incorporates authentication and token verification for secure user access, ensuring data privacy and integrity. Our project aims to provide an accessible, reliable, and cost-effective tool to assist healthcare professionals and individuals in the early detection of skin diseases, potentially improving patient outcomes and reducing the burden on dermatology services

Focal liver lesions: multiparametric microvasculature characterization via super-resolution ultrasound imaging

BackgroundNoninvasive and functional imaging of the focal liver lesion (FLL) vasculature at microscopic scales is clinically challenging. We investigated the feasibility of using super-resolution ultrasound (SR-US) imaging for visualizing and quantifying the microvasculature of intraparenchymal FLLs.MethodsPatients with FLLs between June 2022 and February 2023 were prospectively screened. Following bolus injection of microbubbles at clinical concentration, SR-US was performed using a high frame rate (350–500 Hz) modified ultrasound scanner and a convex array transducer with a central frequency of 3.1 MHz.ResultsIn total, 47 pathologically proven FLLs at a depth of 5.7 ± 1.7 cm (mean ± standard deviation) were included: 30 hepatocellular carcinomas (HCC), 11 liver metastases (LM), and 6 focal nodular hyperplasias (FNH). The smallest detectable vessel size of the hepatic microvasculature was 128.4 ± 18.6 μm (mean ± standard deviation) at a depth of 8 cm. Significant differences were observed among the three types of lesions in terms of pattern categories, vessel density, minimum flow velocity, and perfusion index. We observed higher vessel density for FNH versus liver parenchyma (p < 0.001) as well as fractal dimension and local flow direction entropy value for FNH versus HCC (p = 0.002 and p < 0.001, respectively) and for FNH versus LM (p = 0.006 and p = 0.002, respectively).ConclusionMultiparametric SR-US showed that these three pathological types of FLLs have specific microvascular phenotypes. Vessel density, fractal dimension and local flow direction entropy served as valuable parameters in distinguishing between benign and malignant FLLs.Trial registrationClinicalTrials.gov (NCT06018142).Relevance statementMultiparametric SR-US imaging offers precise morphological and functional assessment of the microvasculature of intraparenchymal focal liver lesions, providing insights into tumor heterogeneity and angiogenesis.Key PointsSuper-resolution (SR)-US imaging allowed morphological and functional evaluation of intraparenchymal hepatic lesion microvasculature.Hepatocellular carcinoma, liver metastasis, and focal nodular hyperplasia exhibit distinct microvascular architectures and hemodynamic profiles.Multiparametric microvasculature characterization via SR-US imaging facilitates the differentiation between benign and malignant microvascular phenotypes.Graphical

Performance of Warmblood horses following tenoscopic desmotomy of the main part of the accessory ligament of the superficial digital flexor tendon for treatment of tendinopathy: 62 cases.

Desmotomy of the accessory ligament of the superficial digital flexor tendon (AL-SDFT) has been described for the treatment of superficial digital flexor tendon (SDFT) tendinopathy in Thoroughbred and Standardbred racehorses, and in event horses. To our knowledge, the outcome of this procedure has not been described in a population of warmblood horses. To report on the outcome of treatment of SDFT tendinopathy in warmblood horses using tenoscopic desmotomy of the main part of the AL-SDFT. Prospective observational case series. All 62 horses included in the case series had uni- or bilateral SDFT tendinopathy within the metacarpal/carpal region. The following data were collected and analysed using crosstabulations: breed, age, sex, use, affected limb(s), duration of tendinopathy, lameness grade, type and size of the SDFT lesion, bi- or unilateral desmotomy, duration of surgery, intraoperative findings, intraoperative/post-operative complications, duration of hospitalisation and outcome 24 months after surgery. Forty-six horses (75%) were sound with 31 (51%) of these horses performing at the same level as prior to injury. Recurrent SDFT injuries or persistent lameness was observed in 15 (25%) horses. Two horses (3%) developed septic tenosynovitis post-operatively, one required euthanasia. Horses with lesions in the proximal third of the SDFT had a better outcome than those with lesions in the two distal thirds (OR = 4.71, 95% CI = 1.33-16.70). There were no control groups of horses with SDFT tendinopathy treated by conservative therapy, tenoscopic complete or conventional open desmotomy. Tenoscopic desmotomy of the main part of the AL-SDFT is a successful treatment for SDFT tendinopathy in warmblood horses, especially in proximal SDFT lesions.

The fuzzy MAD stroke conjecture, using fuzzy C means to classify multimodal apparent diffusion for ischemic stroke lesion stratification

BackgroundIn conjunction with an epidemiologically determined treatment window, current radiological acute ischemic stroke practice discerns two lesion (stage) types: core (dead tissue, identified by diffusion-weighted imaging (DWI)) and penumbra (tissue region receiving just enough blood flow to be potentially salvageable, identified by the perfusion diffusion mismatch). However, advancements in preclinical and clinical studies have indicated that this approach may be too rigid, warranting a more fine-grained patient-tailored approach. This study aimed to demonstrate the ability to noninvasively provide insights into the current in vivo stroke lesion cascade. MethodsTo elucidate a finer-grained depiction of the acute focal ischemic stroke cascade in vivo, we retrospectively applied our multimodal apparent diffusion (MAD) method to multi-b-value DWI, up to a b-value of 10,000 s/mm2 in 34 patients with acute focal ischemic stroke. Fuzzy C Means was used to cluster the MAD parameters. ResultsWe discerned 18 clusters consistent with normal appearing tissue (NAT) types and 14 potential ischemic lesion (stage) types, providing insights into the variability and aggressiveness of lesion progression and current anomalous stroke-related imaging features. Of the 529 ischemic stroke lesion instances previously identified by two radiologists, 493 (92 %) were autonomously identified; 460 (87 %) were identified as efficaciously or better than the radiologists. ConclusionsThe data analyzed included a small number of clinical patients without follow-up or contemporaneous histology; therefor, the findings and theorizing should be treated as conjecture. Nevertheless, each identified NAT and lesion type is consistent with the known underpinnings of physiological tissues and pathological ischemic stroke lesion (stage) types. Several findings should be considered in current clinical imaging: WM fluid accumulation, BBB compromise conundrum, b1000 identified core may not be dead tissue, and a practical reason for DWI (pseudo) normalization.

Dissecting the heterogeneity of craniofacial lesions in patients with fibrous dysplasia/McCune–Albright Syndrome

Fibrous dysplasia/McCune–Albright Syndrome (FD/MAS) frequently involves the craniofacial skeleton. Craniofacial fibrous dysplasia lesions exhibit diverse imaging characteristics on multimodality evaluation, utilizing radiographs, computed tomography (CT), magnetic resonance imaging (MRI), and 18F-sodium fluoride positron emission tomography (18F-NaF PET). A multimodal imaging classification of craniofacial fibrous dysplasia lesions may offer clinical insights into the types of lesions that are (1) prone to progression, (2) amenable to intervention (i.e., pharmacological or surgical), or (3) associated with symptoms such as pain. In this prospective, preliminary single site study of 15 patients with FD/MAS, the heterogeneity of craniofacial lesions (N = 35) was assessed using a combination of 18F-NaF PET, MRI, and CT. A k-means clustering algorithm was used to categorize lesions based on imaging characteristics. Clustering analysis revealed three types of lesion based on the magnitude of the regional 18F-NaF standardized uptake values (SUV), signal intensities on T1-weighted and fluid-sensitive sequences, and appearance on CT (lucent, sclerotic, and/or ground glass). This preliminary study provides a foundation for future longitudinal natural history or treatment studies, where the prognostic value of baseline craniofacial fibrous dysplasia imaging characteristics and clinical symptomatology can be further evaluated.

Leukocyte segmentation based on DenseREU-Net

The detection of white blood cells provides important information in cellular research regarding infections, inflammation, immune function, and blood pathologies. Effective segmentation of WBCs in blood microscopic images not only aids pathologists in making more accurate diagnoses and early detections but is also crucial for identifying the types of lesions. Due to significant differences among various types of pathological WBCs and the complexities associated with cellular imaging and staining techniques, accurately recognizing and segmenting these different types of WBCs remains challenging. To address these challenges, this paper proposes a WBC segmentation technique based on DenseREU-Net, which enhances feature exchange and reuse by employing Dense Blocks and residual units. Additionally, it introduces mixed pooling and skip multi-scale fusion modules to improve the recognition and segmentation accuracy of different types of pathological WBCs. This study was validated on two datasets provided by DML-LZWH (Liuzhou Workers’ Hospital Medical Laboratory). Experimental results indicate that on the multi-class dataset, DenseREU-Net achieves an average IoU of 73.05% and a Dice coefficient of 80.25%. For the binary classification blind sample dataset, the average IoU and Dice coefficient are 83.98% and 90.41%, respectively. In both datasets, the proposed model significantly outperforms other advanced medical image segmentation algorithms. Overall, DenseREU-Net effectively analyzes blood microscopic images and accurately recognizes and segments different types of WBCs, providing robust support for the diagnosis of blood-related diseases.

Diagnostic Performance of Cytocolposcopy versus Biopsy for Premalignant and Malignant Lesions in a Women's Hospital Dysplasia Clinic

Background: Cervical cancer (CRC) is a public health problem because it is the fourth most common gynecologic neoplasm worldwide. The screening tests used to diagnose this pathology are cervical cytology, which in suspected malignancy or with malignancy requires colposcopy to identify the affected area and thus guide the biopsy, which is the gold standard for diagnosis. Therefore, these tests are complementary, and a high diagnostic concordance is required to make a confident diagnosis. Subjects and Methods: A retrospective, cross-sectional, observational, and analytical study was performed. A total of 1470 medical records were analyzed, of which 175 patients met the inclusion criteria. The cyto-colposcopic diagnostic yield was compared with the histopathologic yield. The concordance between screening tests and the gold standard was calculated using Cohen's kappa coefficient Results: The sample comprised 175 subjects who met the selection criteria (11.9%). The mean age was 34.59 + 11.01 years, ranging from 17 to 65 years. The mean sexual debut was 16.6 years, with a mean of 3.1 ± 2 sexual partners. When patients were classified according to lesion type, the highest percentages were found in low-grade squamous intraepithelial lesions (LSIL). With 45.71, 61.14, and 49.14% for cytologic, colposcopic, and histopathologic examination, respectively. The highest concordance between histopathology and cytology was found in the high-grade squamous intraepithelial lesion (HSIL) with 0.41, and the concordance between histopathology and colposcopy in HSIL and cancer was 0.55 and 0.74, respectively. Conclusions: Papanicolaou tests and colposcopy showed moderate concordance with histopathologic findings; the diagnostic accuracy of colposcopy is superior to that of cytology.

Intraoperative Intermittent Pneumatic Compression Reduces Incidence of Venous Thromboembolism in Patients Undergoing Craniotomy: Study Protocol of a Randomized Multicenter, Single-Blind Trial

BACKGROUND AND OBJECTIVE: Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common complication in craniotomy patients. The duration of surgery has been identified as a risk factor for the development of VTE. In a pilot study, the use of intermittent pneumatic venous compression (IPC) dramatically reduced the incidence of VTE. Despite randomization, a significant difference in the duration of surgery between the groups limited the validity of this result. The study was underpowered to compensate for this problem. We now present the protocol of a multicenter trial. METHODS: All patients receive medical compression stockings and low-molecular-weight heparin from the first postoperative day. The therapy group receives IPC stockings intraoperatively. Postoperatively, all patients receive lower-extremity duplex sonography to detect/exclude DVT within the first 7 postoperative days. Contrast-enhanced chest CT is the gold standard for the detection of PE and is performed in cases of clinical suspicion of PE. EXPECTED OUTCOMES: The incidence of VTE is the primary end point. The distinction between symptomatic and asymptomatic, etiologies, influence of lesion type, duration of surgery, and mortality will be evaluated as secondary end points. The pilot study showed a VTE incidence of 26% in the control group vs 7% in the treatment group. To avoid overly optimistic treatment effect assumptions, we assume VTE rates of 9% and 24% in the treatment and control groups, respectively, and thus calculated a number of 127 patients per treatment group. DISCUSSION: If this trial shows that intraoperative IPC reduces the risk of VTE to the extent observed in our pilot study (number needed to treat: 5.24), the potential benefit to neurosurgical patients would be significant. The results would potentially influence treatment guidelines by providing the high-quality evidence needed to make robust recommendations.

Current Operating Procedure (COP) for Bleomycin ElectroScleroTherapy (BEST) of low-flow vascular malformations.

Bleomycin ElectroScleroTherapy (BEST) is a new approach in the treatment of vascular malformations. After bleomycin is administered to the malformation, electric pulses are applied to the target area to enhance the effectiveness of bleomycin. The mode of action is comparable to the effect of electrochemotherapy on tumour vasculature. For the wider and safer use of BEST in the clinical treatment of low-flow vascular malformations, this Current Operating Procedure (COP) is being prepared. It is a proposal for the clinical standardisation of BEST using the Cliniporator® as the electrical pulse generator with its associated electrodes. The electrical parameters considered in this protocol are those validated by the European Standard Operating Procedures for Electrochemotherapy (ESOPE) with the Cliniporator®. General requirements are proposed, and, depending on the type of lesion, local skills and the availability of radiological equipment, two technical approaches of BEST are described based on ultrasound guided intervention or combined ultrasound and fluoroscopic guided intervention.

Central pontine myelinolysis in anorexia nervosa: case report of a Chinese adolescent

Central pontine myelinolysis (CPM) is a rare neurologic disorder characterized by symmetric demyelination in the central region of pons. Until recently its prognosis was considered poor if not fatal. CPM may manifest as a severe complication of eating disorders, especially anorexia nervosa (AN), primarily due to a rapid correction of hyponatremia. In this report, we presented the case of a 13-year-old girl with a five-month history of AN who exhibited typical CPM brain lesions, confirmed by magnetic resonance imaging (MRI) examination without the context of severe electrolyte imbalances. Surprisingly, despite the patient’s critical clinical manifestations in the initial stages, her prognoses of both AN and CPM were relatively optimistic. We discussed these observations in the light of recent reports on CPM and AN comorbidity. Although the clinical implications of MRI-detected lesions remain uncertain, psychiatrists should be cautious about CPM when refeeding patients with AN. Further studies about the relationship between CPM and AN are imperative.

Paediatric brain lesions: a study of space-occupying conditions

Background: Intracranial space-occupying lesions (ICSOL) in children, encompassing neoplastic and inflammatory origins, pose significant diagnostic and therapeutic challenges. Modern imaging techniques like CT and MRI have revolutionized the understanding and management of ICSOL, altering their clinical presentation. This study aimed to investigate the epidemiology, clinical presentation, etiology, treatment modalities and outcomes of ICSOL in pediatric patients. Methods: A prospective analysis was conducted on pediatric patients diagnosed with ICSOL, utilizing medical records from a tertiary care hospital. Data regarding demographics, clinical symptoms, imaging findings, treatment modalities, and outcomes were collected and analyzed. Results: In this study on space-occupying lesions (SOL) in pediatric patients, revealing a diverse distribution across different age groups. Arachnoid cysts were the most prevalent, followed by hydrocephalus, hematomas, and tuberculomas. Clinical presentations varied widely, with Headache, Seizures and altered sensorium in limbs being the most common symptoms. Treatment approaches ranged from surgical resection or fenestration for arachnoid cysts to specific therapies such as ventriculoperitoneal shunt placement for hydrocephalus and antitubercular therapy for tuberculomas. Outcomes varied by lesion type, with some cases showing improvement, stability or worsening post-treatment. Conclusions: The study provides valuable insights into the epidemiology, clinical presentation, treatment, and outcomes of space-occupying lesions in children. Arachnoid cysts emerged as the predominant lesion type, while hydrocephalus, hematomas and tuberculomas were also notable. Understanding these factors is crucial for early diagnosis, effective management and improved outcomes in pediatric patients with brain lesions.

“Chasing Rainbows” Beyond Kaposi Sarcoma’s Dermoscopy: A Mini-Review

The dermoscopic rainbow pattern (RP), also known as polychromatic pattern, is characterized by a multicolored appearance, resulting from the dispersion of polarized light as it penetrates various tissue components. Its separation into different wavelengths occurs according to the physics principles of scattering, absorption, and interference of light, creating the optical effect of RP. Even though the RP is regarded as a highly specific dermoscopic indicator of Kaposi’s sarcoma, in the medical literature, it has also been documented as an atypical dermoscopic finding of other non-Kaposi skin entities. We aim to present two distinct cases—a pigmented basal cell carcinoma (pBCC) and an aneurysmatic dermatofibroma—that exhibited RP in dermoscopy and to conduct a thorough review of skin conditions that display RP, revealing any predisposing factors that could increase the likelihood of its occurrence in certain lesions. We identified 33 case reports and large-scale studies with diverse entities characterized by the presence of RP, including skin cancers (Merkel cell carcinoma, BCC, melanoma, etc.), adnexal tumors, special types of nevi (blue, deep penetrating), vascular lesions (acroangiodermatitis, strawberry angioma, angiokeratoma, aneurismatic dermatofibromas, etc.), granulation tissue, hypertrophic scars and fibrous lesions, skin infections (sporotrichosis and cutaneous leishmaniasis), and inflammatory dermatoses (lichen simplex and stasis dermatitis). According to our results, the majority of the lesions exhibiting the RP were located on the extremities. Identified precipitating factors included the nodular shape, lesion composition and vascularization, skin pigmentation, and lesions’ depth and thickness. These parameters lead to increased scattering and interference of light, producing a spectrum of colors that resemble a rainbow.

Implementation of MobileNet Architecture for Skin Cancer Disease Classification

As the number of occurrences of skin cancer increases year, it becomes more and more crucial to identify the disease accurately and effectively. This study aims to implement and evaluate the MobileNet architecture for classifying nine types of skin lesions using the ISIC 2020 dataset and to compare MobileNet's performance with other CNN architectures, such as VGG-16 and LeNet, in terms of accuracy and computational efficiency. The study also investigates the impact of image preprocessing on model accuracy. The methodology comprises data collection, preprocessing, and model development, leveraging transfer learning from MobileNet pre-trained on ImageNet. Data preprocessing involves resizing images to 224 x 224 pixels and normalizing pixel values. To augment the dataset, techniques such as rotation, zooming, horizontal flipping, and brightness and contrast adjustment are applied. To address class imbalance, oversampling is used to obtain 500 images per class. The model architecture includes Global Average Pooling, a Dense layer with 1024 units and ReLU activation, and a Dropout layer with a 0.2 probability. Various training scenarios with batch sizes (8, 16, 32, 64) and learning rates (0.001, 0.0001) are evaluated, incorporating dropout and ReLU activations. The optimal performance was achieved with oversampling, dropout, and a learning rate of 0.0001, yielding a training accuracy of 99.64% and a validation accuracy of 86.89% after oversampling, resulting in 3,600 training and 900 validation images with an 80:20 data split. The results suggest overfitting due to dataset limitations. Future work should focus on fine-tuning and ensemble methods to improve validation performance.