Nape Research Articles

Asuhan Keperawatan Keluarga pada Ny. S dengan Gangguan Sistem Kardiovaskular : Hipertensi di Desa Kalibuntu RT 02 RW 03 Kecamatan Losari Kabupaten Brebes

Hypertension is still one of the problems that exist in the community today. Ordinary people know hypertension as high blood pressure because this disease has a high increase in blood pressure outside normal limits (Marbun and Hutapea 2022). The purpose of this writing is to be able to make and apply Family Nursing Care to Mrs S with Cardiovascular System Disorders: Hypertension in Kalibuntu Village Rt 02 Rw 03 Losari District, Brebes Regency. This writing method uses a descriptive method with a nursing process approach study. The results of nursing care Clients often feel dizzy and headache, the back of the head feels heavy. Pain in the nape of the neck. Pain increases during activity and decreases when resting. Pain like being cut into pieces. Pain in the nape of the neck. Pain scale 4 (moderate pain). Pain is intermittent. The client said he knew about hypertension, but did not know in detail about what causes hypertension, signs and symptoms of hypertension, and how to prevent and treat complaints. The nursing diagnoses raised are acute pain and knowledge deficit. Interventions are carried out based on SIKI and implementation based on interventions that have been designed. In the evaluation of the two diagnoses there is one resolved diagnosis, namely knowledge deficit, partially resolved diagnoses, namely acute pain. The results of nursing care have no gaps with theory. Writing i

Asuhan Keperawatan Keluarga Tn. M dengan Gangguan Sistem Muskuloskeletal : Rheumatoid Arthritis di Desa Kalibuntu RT 02 RW 02 Kecamatan Losari Kabupate Brebes

Rheumatoid arthritis is a degenerative disease that attacks the joints, especially in the elderly. The purpose of this paper is to determine and provide nursing care for Mr. M’s family with musculoskeletal system disorders: rheumatoid arthritis in Kalibuntu Village Rt 02 Rw 02 Losari District Brebes Regency according to nursing standards. The method used is a data collection method in the form of interviews, observation, research documentation and physical examination. From the case review, it was found that the client’s main complaint was pain in the nape of the neck and right and left knees especially when waking up, P: pain in the morning when waking up, Q: pain like being cut into pieces, R: nape, right and left knees, S: scale 4, T: intermittent. The nursing problems found were acute pain and knowledge deficit. Interventions were arranged based on the theory in SDKI, SLKI and SIKI as well as on the client’s condition and could be implemented.

Greenish discoloration over the nape of neck

Greenish discoloration over the nape of neck

Understanding Nuchal Type Fibroma: A Rare Case Report with Comprehensive Discussion

Introduction and Aim: Nuchal-type fibroma (NTF) is a rare benign fibrous proliferation primarily originating from the dorsocervical neck region. Enzinger and Weiss first characterized it in 1988, highlighting its distinct histopathological features. Description of the Case Report: We present a case of 71-year-old South Asian male patient with painless swelling over the nape of neck, highlighting the challenges in diagnosis of NTF. Clinical examination, imaging, and cytological findings initially suggested a lipomatous lesion. Histopathological evaluation revealed characteristic features consistent with NTF, emphasizing the importance of histopathological assessment for accurate diagnosis. Despite its benign nature, vigilance is essential due to the potential for recurrence. Conclusion: This case underscores the need for a comprehensive understanding of NTF's clinical and histopathological features to facilitate optimal management and improve patient outcomes.

Spinal histamine H4 receptor mediates chronic pruritus via p-ERK in acetone-ether-water (AEW)-induced dry skin mice.

Dry skin is common to many pruritic diseases and is difficult to improve with oral traditional antihistamines. Recently, increasing evidence indicated that histamine H4 receptor (H4R) plays an important role in the occurrence and development of pruritus. Extracellular signal-regulated kinase (ERK) phosphorylation activation in the spinal cord mediates histamine-induced acute and choric itch. However, whether the histamine H4 receptor regulates ERK activation in the dry skin itch remains unclear. In the study, we explore the role of the histamine H4 receptor and p-ERK in the spinal cord in a dry skin mouse model induced by acetone-ether-water (AEW). q-PCR, Western blot, pharmacology and immunofluorescence were applied in the study. We established a dry skin itch model by repeated application of AEW on the nape of neck in mice. The AEW mice showed typically dry skin histological change and persistent spontaneous scratching behaviour. Histamine H4 receptor, instead of histamine H1 receptor, mediated spontaneous scratching behaviour in AEW mice. Moreover, c-Fos and p-ERK expression in the spinal cord neurons were increased and co-labelled with GRPR-positive neurons in AEW mice. Furthermore, H4R agonist 4-methyhistamine dihydrochloride (4-MH)induced itch. Both 4-MH-induced itch and the spontaneous itch in AEW mice were blocked by p-ERK inhibitor U0126. Finally, intrathecal H4R receptor antagonist JNJ7777120 inhibited spinal p-ERK expression in AEW mice. Our results indicated that spinal H4R mediates itch via ERK activation in the AEW-induced dry skin mice.

The use of a penetrative captive bolt device during the killing of farmed saltwater crocodiles (Crocodylus porosus)

ABSTRACT Killing of farmed saltwater crocodiles involve stunning with a penetrative captive bolt device, followed by a cut across the nape of the neck and physical destruction of the brain to ensure death. This study was a welfare-based assessment of the use of a penetrative captive bolt device in saltwater crocodiles, to determine whether it satisfies the criteria of a humane stunning method and can be regarded as a direct killing method without the need for the application of an adjunct method. Methods used were electroencephalogram (EEG), observation of post-stun behavior, and postmortem examination of gross pathology of the cranium and brain. 30 of 30 animals, demonstrated immediate and irreversible loss of consciousness. There was extensive damage to the brain in all animals, deemed to be inconsistent with cortical function and possible recovery. The CASH Special 0.22 penetrative captive bolt pistol (1.25 grain cartridge), applied to the top of the cranial plate, produced immediate and irreversible unconsciousness in all the animals studied. This method satisfies animal welfare expectations, providing crocodile processors with a technique that contributes to a humane killing process.

Analysis of tera gymnastic as an intervention of acute pain nursing problems in elderly families with hypertension

Background: One of the problems that occurs in the elderly is hypertension. Hypertension has many symptoms, including dizziness, fatigue, and difficulty sleeping, and one of them is acute pain in the nape of the neck. In treating pain, there are two methods of treatment: pharmacological techniques and non-pharmacological treatments. One of the non-pharmacological treatments is tera exercise. Terra exercise is an alternative way to reduce pain. Objective: To analyze the implementation of acute pain nursing care for elderly families who experience hypertension problems in Trayeman Pleret Hamlet, Bantul. Method: This research method uses descriptive methods. The approach used is a case study with the management of one case using a nursing care process approach involving elderly families who experience acute pain nursing problems with hypertension. Results: After performing tera exercises three times for ± 60 minutes, participants said the pain had decreased from a pain scale of 5 to 2. Conclusion: The application of tera exercise can reduce the problem of acute pain nursing in elderly families with hypertension.

An Indian Expert Group Review of Acanthosis Nigricans with Recommendations for Early Detection and Timely Management.

Acanthosis nigricans (AN) is a visible cutaneous manifestation of several underlying systemic conditions, such as prediabetes, diabetes mellitus (DM), polycystic ovarian syndrome (PCOS), metabolic syndrome (MS), and malignancy. AN is commonly seen in obese individuals and is a proven skin marker of insulin resistance (IR). Its typical clinical presentation and location, especially on the nape of the neck, allows for easy visual identification. Obesity, IR, and other noncommunicable diseases (NCD) are on the rise in India, with many cases being undiagnosed or missed. Every sixth diabetic in the world is Indian. AN can thus play a vital role in screening, early identification, and reduction of morbidity, especially of IR-related disorders. Currently, there are no national or international multidisciplinary guidelines or recommendations for AN. To review published current literature and evidence on AN, its associations, and management. To recommend an approach to clinical identification of AN, associated/underlying disorders, investigations, and management, including lifestyle modifications. To sensitize and familiarize clinicians and healthcare workers across India with AN presentations. This will enable early detection of conditions such as IR, prediabetes, DM, PCOS, malignancy, etc., in practice and in the community. The PCOS Society of India constituted a multispecialty Expert Working Group with representation from various national societies to review all published scientific evidence. Expert group meetings were conducted to provide recommendations. Acanthosis nigricans is a simple, non-invasive, cost-effective screening tool for early identification of IR. It is important to integrate and disseminate information and training on AN across medical specialties. The government of India has launched several National Health Programmes to help address the rising burden of NCD in the population. AN would provide a simple screening tool to pick up undiagnosed or missed cases.

Spindle Cell Lipoma and Pleomorphic Lipoma in the Head and Neck: A Comprehensive Study of Six Cases With Review of Literature.

Spindle cell lipomas (SL) and pleomorphic lipomas (PL) are rare variants of lipomas, occurring predominantly in the head and neck region. Laryngeal SL/PL is very uncommon and causes obstructive symptoms needing immediate intervention. These tumors are often challenging in radiology due to the admixture of elements and the presence of adipose tissue may help in diagnosis. From a surgeon's perspective, understanding the nuances of SL/PL is paramount. Histology is the gold standard for diagnosis; however, it often causes diagnostic challenges in biopsy. Method: A retrospective review of the clinical and pathologic features of archival cases of SL/PL was performed. A total of six cases of head and neck region SL/PL were identified. The age of patients ranged from 21 to 58 years and the male-to-female ratio was 5:1. The tumors were distributed in the nape of the neck (n=3), laryngeal region (n=2), and orbit (n=1). Histology in all the cases showed a low-grade neoplasm composed of a variable amount of spindle cells and adipose tissue. The stroma was myxoid in most cases. CD34 was diffusely positive in all the cases. SLs are a rare and uncommon variant of lipoma with a predilection in the head and neck region. They are low-grade neoplasms with a propensity to recur after years. Having knowledge of this tumor can improve surgical outcomes and better patient care.

Ileal Atresia in Down Syndrome, A Rare Finding

A 37-week-old baby boy was born by cesarean section to a 40-yearold G7P6006 mother who tested positive for 21+ by noninvasive prenatal testing. At delivery, the baby had features of Down Syndrome, including low-set ears, bilateral epicanthal folds, a flat nasal bridge, a protruding tongue, a Simian crease on the right hand, an umbilical hernia, and excess skin on the nape of the neck. He presented with Apgar’s of 7 and 8. He was admitted to the NICU requiring CPAP due to respiratory distress, kept NPO, and started on IV fluids. When feeds were started at the end of the first day of life, he was noted to have episodes of bilious emesis, with abdominal distention, and failure to pass meconium till 36 hours of life.

Role of Viddha Karma in Management of Galaganda

Background: In Ayurveda, Galaganda which is characterized by neck swelling is well known. Galaganda is often compared with Goiter which is related with Thyroid disorders. Aaharaja and Viharaja Hetus cause vitiation in Vata, Kapha and Meda. These vitiated Doshas reach the neck and the Nape of the neck gets lodged therein causing swelling in the neck which gradually develops having their respective symptoms. Case Report: In this present study an Indian Female Patient aged 30 years known case of Hyperthyroidism and swelling over the neck for 1 year was treated by Viddha Karma Therapy. Result: The 7 consequent sittings of Viddha Karma led to regression of the size of Thyroid Gland as well as reduction of cervical lymphadenopathy and thus provided relief in signs and symptoms. Also, there were positive significant changes observed in the Thyroid profile and USG reports. This is an effort to find a better and faster treatment for Galaganda by successfully treating the case of Galaganda with Viddha Karma Therapy.

Peculiar Pattern of Irritant Contact Dermatitis to Semecarpus anacardium

Abstract Semecarpus anacardium (Family: Anacardiaceae), is a frequently used medicinal plant in alternative medicine. There has been few case reports suggesting the role of marking nut extract in allergic contact dermatitis. Case one presented with vesicles coalescing to form bullae with surrounding necrotic epidermis accompanied by itching and burning sensation over nape of neck. He developed recurrent urticarial episodes post treatment. Case two reported similar lesions over beard region after 2 weeks of our index case in addition to diffuse erythematous maculopapular pruritic rash over upper chest, face and anterior shoulder. Case three, four and five reported with similar kind of lesions over various body parts. Case six presented with targetoid lesion with central bullae over upper torso. Case seven reported with bizarre lesions like splattering of chemical which were morphologically similar as the other cases, over left popliteal fossa and calf area. Our cases were from the same geographic area and were in the same profession. On evaluation of the pattern and morphology of lesions and careful investigation, it was concluded that it was an irritant reaction to Semicarpus nut extract which was supported by histopathology findings. On further probing, it was observed that the individuals inflicted the injury in order to avoid some strenuous work. All were evaluated and none of them were found to be suffering from any psychiatric ailment. We reported this case series because of unique morphological presentation which has not yet been reported in the literature to the best of our knowledge.

Anti-transcription intermediary factor 1 gamma antibody-associated paraneoplastic dermatomyositis: A case report

Dermatomyositis (DM) is an inflammatory myopathy characterized by distinctive cutaneous manifestations. Recent advancements have led to the identification of a novel myositis-specific autoantibody called anti-transcription intermediary factor 1 gamma (anti-TIF-1-γ) which presents with unique cutaneous manifestations and a heightened risk for malignancy. We report a case of a 55-year-old female who presented with proximal muscle weakness, an erythematous rash over the face, blanching erythema over the nape of the neck, and red-on-white lesions over the chest. She was diagnosed with anti-TIF-1-γ positive DM and found to have a palpable mass in the right breast. Biopsy showed triple negative invasive breast carcinoma no special type (NST) grade 3. She showed poor response to steroids and was referred for cancer staging and treatment. The anti-TIF-1-γ antibody serves as a novel tool to identify a subset of DM patients at high risk for cancer. At present, its role in the prognosis or surveillance of cancer recurrence remains uncertain.

Differential diagnosis of sclerosing skin diseases: scleredema adultorum of Buschke

Scleredema adultorum of Buschke is an important differential diagnosis in sclerosing diseases. Diagnosis is based on the typical histology with mucin deposits and grossly increased dermal width and aclinical presentation of diffuse non-pitting induration of the skin starting at the nape of the neck and interscapular region extending to shoulders and upper thorax, causing dysmobility due to dermal stiffness. Even though the pathogenesis remains unclear, three subtypes can be distinguished: association with infections, paraproteins, or most frequently with diabetes mellitus. Management of the disease includes physiotherapy, physical therapies such as ultraviolet (UV) or ionizing irradiation, intravenous immunoglobulins and interdisciplinary treatment directed at associated diseases. Optimizing diabetes therapy and thereby decreasing insulin use may confer significant improvement.

Cobb Syndrome, A Rare Disease – Case Report

Cobb syndrome is a rare genetic disorder characterized by dermatomal pattern, with corresponding muscular, osseous, paraspinal, and/or spinal vascular lesions occurring at the same body somite (metamere). It is also known as spinal arteriovenous metameric syndrome (SAMS) and cutaneous meningospinal angiomatosis. We present a case of a 36 years old male presented to OPD with Complain of progressive weakness of Right upper limb for 5 years. On examination, Patient had large cutaneous port wine stain on the right side of the chest, nape of neck, and along the whole right upper limb in a dermatomal distribution with ulnar claw hand wasting of thenar muscles on right side. MRI cervical spine with contrast showed aggressive vertebral hemangioma involving anterior and posterior arch of C1 vertebra, vertebral body of C2 to C5, right half of vertebral body of C2 and C6 and right pedicle of C2 to C5 vertebra. Abnormal thickened and T2WI /STIR hyperintense skin and subcutaneous tissue involving right half of scalp and right half of neck which showing post contrast enhancement, possibility of subcutaneous hemangioma. Cobb syndrome was diagnosed based on the dermatomal distribution of the cutaneous vascular lesions and the corresponding vertebral, epidural, and paraspinal vascular lesions occurring at the same metamere. Treatment decision is guided by the patient’s symptoms and imaging features.

Systemic peptide amphiphile nanofiber delivery following subcutaneous injection

Peptide amphiphile (PA) nanofibers have been shown to target and deliver drugs when administered via an intravenous (IV) injection. Subcutaneous administration can broaden the applicability of PA nanofibers in the medical field. The ability of PA nanofibers to be absorbed into systemic circulation after subcutaneous administration was investigated. Four PA molecules with different amino acid sequences were designed to understand the effect of nanofiber cohesion and charge on uptake. Solution small-angle X-ray scattering confirmed nanostructure morphology and provided characteristic lengths for co-assemblies. Circular dichroism and solution wide-angle X-ray scattering confirmed PA secondary structure and molecular order. PAs were co-assembled in a 95 %:5 % molar ratio of unlabeled PA to fluorescently labeled PA. Male and female Sprague Dawley rats were injected in the nape of the neck with PA co-assemblies. In vivo normalized abdominal fluorescence was measured 1–72 h after injection. PA nanofibers with a negative charge and low internal order showed the highest amount of systemic absorption at 1, 6, and 24 h. At 24 h after injection, white blood cell count decreased and glucose was elevated. Glucose began to decrease at 48 h. These data indicate that PA nanofibers can be absorbed into the systemic circulation after subcutaneous injection.

Managing difficult airway in a post burn neck contracture: A case report

Post burns neck contracture is always considered a difficult airway and requires meticulous planning for proper management. Awake fiberoptic intubation (AFOI) have been gold standard for managing difficult airways [1]. Here we will discuss a case of difficult airway due to post burn contractures at the neck posted for debridement and Split Skin Grafting (SSG) for Marjolin’s ulcer at the nape of the neck. Internal changes in the airway due post inhalational injury fibrosis proved the major cause of difficulty and following traditional clinical teachings helped in successful management of airway.

Surgical emphysema and pneumothorax: Unfamiliar combination in Ehlers-Danlos syndrome

A 53-year-old gentleman presented with sudden onset swelling over the neck for the past 5 days. It was associated with dyspnoea on exertion. He was a known patient of Ehlers-Danlos syndrome since sixteen years of age. Initially, the swelling appeared over the neck which gradually progressed over to the anterior chest wall and the nape of the neck. There was no history of trauma, fever, surgery or similar complaints in the past. He was a known smoker. On examination, there was diffuse subcutaneous emphysema over the neck, and the anterior chest wall (Figure 1). Skin crepitus was present. The skin was hyper-extensile, fragile and easily stretchable (Figure 1). The patient was vitally stable. On rigid laryngoscopy, bilateral vocal cords were mobile. We admitted the patient and performed a CT scan of the neck and chest to assess the extent of the emphysema. CT scan confirmed an extensive subcutaneous emphysema over the neck, extending posterior to the oesophagus. There were multiple emphysematous bullae over the apical region of the right lung and an area of pneumothorax just in the vicinity of the bullae (Figure 2). The patient was planned for incision and evacuation of the air. A horizontal incision was given over the most prominent part of the swelling and the air was milked out gently. An Intercostal Chest Drain (ICD) was inserted and the condition was closely monitored. The recovery was uneventful. He was discharged after seven days of hospital stay.

Mechanisms of the PD-1/PD-L1 pathway in itch: From acute itch model establishment to the role in chronic itch in mouse

Programmed cell death receptor/ligand 1 (PD-1/PD-L1) blockade therapy for various cancers induces itch. However, few studies have evaluated the mechanism underlying PD-1/PD-L1 inhibitor-induced itch. This study aimed to establish and evaluate a mouse model of acute itch induced by PD-1/PD-L1 inhibitors and to explore the role of the PD-1/PD-L1 pathway in chronic itch. The intradermal injection of the PD-1/PD-L1 small molecule inhibitors, or anti-PD-1/PD-L1 antibodies in the nape of the neck in the mice elicited intense spontaneous scratches. The model was evaluated using pharmacological methods. The number of scratches was reduced by naloxone but not by antihistamines or the transient receptor potential (TRP) channel inhibitor. Moreover, the PD-1 receptor was detected in the spinal cord of the mouse models of chronic itch that exhibited acetone, diethyl ether, and water (AEW)-induced dry skin, imiquimod-induced psoriasis, and 1-fluoro-2,4-dinitrobenzene (DNFB)-induced allergic contact dermatitis. Intrathecal PD-L1 (1 μg, 4 times a week for 1 week) suppressed the activation of the microglia in the spinal dorsal horn to relieve the chronic itch that was elicited by imiquimod-induced psoriasis and DNFB-induced allergic contact dermatitis. Although the activation of the microglia in the spinal dorsal horn was not detected in the AEW-treated mice, intrathecal PD-L1 still reduced the number of scratches that were elicited by AEW. Our findings suggest that histamine receptor inhibitors or TRP channel inhibitors have limited effects on PD-1/PD-L1 inhibitor-induced itch and that spinal PD-1 is important for the spinal activation of the microglia, which may underlie chronic itch.

Translated article] Outbreak of Dermatophyte Infections on the Head and Neck Related to Shave Haircuts: Description of a Multicenter Case Series

IntroductionSince 2021, an increase in cases of tinea capitis has been detected in adolescents who shave their hair with fade haircut. Patients and methodsMulticenter retrospective observational study of cases of cephalic pole dermatophytosis with a history of having been acquired after frequent shaving in hairdressing. A call was made to dermatologists from the Spanish Academy of Dermatology and Venereology (AEDV) to provide cases observed between January 2021 and December 2022. Patients with microbiological confirmation by culture or direct examination with KOH were included. Results107 cases were collected, 106 of which were male. 78 non-inflammatory forms were observed, compared to 29 inflammatory. The most frequently isolated fungus was Trichophyton tonsurans (75.7% of cases). The lesions appeared predominantly on the nape of the neck and temporal area. ConclusionsThe distribution by sex, age and lesional location seems to indicate that a new social trend, in which male adolescents regularly go to hairdressers to shave the occipital and temporal areas, would be the cause of this grouping of cases of ringworm of the scalp. The most frequent microorganism in our study (T. tonsurans) coincides with the most prevalent in our environment. This study shows an accumulation of cases that can be taken into account by competent Public Health agencies, which are responsible for ensuring compliance with the rules of disinfection of the material used for shaving.