Treatment Dissecting Cellulitis of the Scalp With Secukinumab.

Hemoglobin (Hb) Bart’s hydrops fetalis is the most severe form of alpha-thalassemia and is usually inherited in an autosomal recessive manner. We report a case of Hb Bart’s hydrops fetalis due to uniparental disomy of chromosome 16. Antenatal screening showed a low maternal mean corpuscular volume (MCV), while paternal MCV was normal. The fetus was found to have a thickened nuchal translucency during first trimester screening for Down’s syndrome. Mid-trimester fetal anomaly ultrasound scan showed fetal cardiomegaly with pericardial effusion, scalp edema, ascites and an elevated middle cerebral arterial peak systolic velocity (MCA PSV). Multiplex polymerase chain reaction (PCR) on DNA from amniocentesis showed that the fetus was homozygous for South East Asian (SEA) type 2 alpha-globin gene deletion. Chromosome microarray (CMA) showed two regions of absence of heterozygosity (AOH) on the terminal p and q arm of chromosome 16. The rare occurrence of Hb Bart’s hydrops fetalis caused by maternal uniparental disomy should be considered in cases of fetal hydrops even in cases where paternal MCV is normal. J Med Cases. 2021;12(7):275-279 doi: https://doi.org/10.14740/jmc3693

Birth injury is an important cause of short and long-term deformity and disability in children. It is becoming an increasing source of litigation in developing countries. Exploring the magnitude of the problem in a resource-limited setting, and, identifying associated factors, will help reduce its occurrence. This surveillance for birth injuries is a 4-year prospective study conducted in the Enugu State University Teaching Hospital (ESUTH) between 2013 and 2017. Newborns with birth injuries and controls delivered around the same time with similar clinic-anthropometric parameters were enrolled for this study. One thousand nine hundred and twenty newborns were seen during the study period. Forty-six birth injuries were recorded giving in-hospital incidence rate of 24.0 (CI 17.3-30.9) per 1000 live birth. Majority (64.1%) of the injuries seen were related to the scalp. The commonest birth injuries encountered included Caput Succedaneum (41.2), Cephalohematoma (22.9), Erb’s Palsy (17.4), and shoulder dislocation (6.5). One case fatality (2.5%) due to skull fracture secondary to forceps delivery was noted. Birth weight (P=0.034), perinatal asphyxia (P=0.001) and prolonged labour (P=0.001) were significantly associated with birth injuries in the newborns surveyed. Birth injury remains a common and serious medical issue in our setting. Being proactive during antenatal care and labour could go a long way in minimizing the incidence of birth injuries and its consequences on children especially in the presence of risk factors such as high birth weight, perinatal asphyxia and prolonged labour. Key words: Birth injuries, newborns, delivery, Enugu.

Background: Cradle cap (Infantile Seborrhoeic Dermatitis), a form of dermatitis that manifested as patches of scale severity on the scalp of infants. The plaque is hard, thick, and tightly scale accompanied by red inflammation resembling a hat, cause itching, discomfort, and causes stress to the parents with a prevalence rate of 3.5% in worldwide distribution. Extract Virgin Olive Oil (EVOO) have an anti-inflammatory, antioxidant, wound healing, skin aging, and reduces the incidence of skin cancer. Purpose: The aim to determine the effect of EVOO with a duration time to recover the cradle cap. Method: This study was a queasy experiment with the control group (was not administered) and the intervention group (was given four drops of EVOO). The population was 21 infants and only five infants with cradle cap in the Siulak Mukai Public Medical Centre area, Kerinci Regency, Jambi. The sampling technique used the purposive sampling technique as much as 10 samplings. Infants are aged 1-4 months, cradle cap confirmed in the head with a low degree (less than 10%) from the frontal area and parietal areas of the infant’s head. The statistical analysis used an independent sample t-test. Result: There were significant differences between the two groups in the duration of recovered the cradle cap (p = 0.000). Further analysis demonstrated a favorable effect of the intervention group with duration time to recovered 10.20 days than the control group is 27.60 days. Conclusion: EVOO is recommended to removing cradle cap in infant and also nourish hair with making the infant's scalp moist by preventing oxidative damage.

Plum-colored plaques on the scalp and extremities

A Painless Bump on Scalp

Basal cell carcinoma (BCC) is the most common skin cancer. We conducted a retrospective study over a period of two years (2018-2019), on 214 patients from the Plastic Surgery clinic in order to identify the clinical and histopathological aspects of the disease: the case distribution according to sex, living environment, age, histopathological subtype, location. Results. The F/M ratio was of 1.03 in favour of women. The incidence was higher for patients from rural areas (55.14%). The most affected group age was between 70-80 years old, with 76 patients (35.51%). The most frequent histological type was nodular basal cell carcinoma (65.42%), followed by micronodular subtype (17.29%). We observed the association of basal cell carcinoma with a number of other conditions such as: high blood pressure (92 cases), diabetes (19 cases), chronic kidney disease (2 cases), liver disease (5 cases), epilepsy (2 cases). Correlating the histopathological subtype and the invasion of the edges of the surgical excision specimen, we noticed that edge invasion was present: in the case of nodular basal cell carcinoma (15.71%), micronodular subtype (43.24%), superficial subtype (50%), morpheaform subtype (40%). Dividing the cases by location, we highlighted the risk areas: nasal region (29.44%), cheek (10.75%), orbital region (13.55%), scalp (10.75%), auricular region (7.48%), forehead (8.41%), etc. Thus, 89.72% of cases were located on photo-exposed areas (head and neck). Patients from rural areas registered a higher number of cases both in photo-exposed and non-exposed areas.

High-density (HD) diffuse optical tomography (DOT), as an advanced modality of functional near-infrared spectroscopy, is finding increasing applications in neuroimaging regime. However, it is a primary challenge that the superficial physiological interferences usually significantly contaminate the functional activation reconstruction. In addition, the random noises, majorly the photon-shot and instrumental ones, also cast negative influences on the measurements, and further distort the reconstructed image. To mitigate the adversities, we herein propose a combined scheme of two-layer semi-three-dimensional (S3D) reconstruction and multi-wavelength image fusion, which leverages a mathematical model with explicit physical significance, to suppress the physiological interferences and random noises in HD-DOT reconstruction, respectively. The approach is purely data-driven without additional auxiliary measurement, and comprised of two steps: First, the absorption perturbations are topographically reconstructed over both the scalp (SC) and cerebral-cortex (CC) layers using the two-layer S3D scheme, of which the superficial interferences are estimated from the SC reconstruction and adaptively filtered out from the CC one; Second, the interference-suppressed multi-wavelength CC-images are decomposed using the discrete wavelet transform, and fused at multi-resolutions into a mask for further removal of the random noises. We comprehensively validate the proposed scheme using simulations and phantom experiments, and demonstrate its sound effectiveness in suppressing the physiological interferences and random noises. The performance improvement rather than by more cycles or longer sampling time offers additional payoff: shorter measurement time or higher temporal resolution.

Large Carcinoma of the Scalp Invading the Meninges

Dermoscopic features of a primary scalp melanoma and its cutaneous metastases.

Nódulos do ordenhador é uma dermatovirose causada por vírus da família Poxviridae, que acometem o homem e animais. Em humanos, apresenta-se em forma progressiva com lesões maculopapulares de base eritematosa passando por formato de alvo, nódulo exsudativo, regenerativo, papilomatoso e cicatricial com crosta. O estudo objetivou descrever um Relato de Caso que contribuirá para conhecimento multiprofissional de saúde nas especialidades infecto-dermatológicas que apresentem manifestações cutâneas semelhantes, a fim de ampliar diagnósticos diferenciais. Trata-se de um estudo retrospectivo, descritivo e observacional no formato de Relato de Caso de um paciente que esteve internado no Hospital de Doenças Tropicais da Universidade Federal do Tocantins (HDT-UFT), localizado no município de Araguaína -TO. Os dados foram coletados por meio de prontuário médico eletrônico e relatório dos profissionais de saúde que realizaram o atendimento, após liberação do Comitê de Ética em Pesquisa da instituição hospitalar e assinatura do Termo de Consentimento Livre e Esclarecido, autorizando a divulgação do trabalho e imagens de forma que não cause constrangimentos ao participante. O paciente apresentou manifestações de lesões clássicas na região palmar, mas com presença também no couro cabeludo e joelho, cujos testes histopatológicos não foram realizados pelas limitações do serviço hospitalar; é importante que os médicos compreendam as formas cutâneas desta doença viral, realizar o tratamento ideal e orientar medidas preventivas de infecção secundária. Deve existir um maior aprofundamento quanto à temática com implementação de medidas de controle pelos órgãos responsáveis pela fiscalização da saúde dos animais bovinos e caprinos leiteiros visando combater o contágio em humanos.

Man With Gnawing Sensation Under His Scalp

Introduction: Low back pain is a common muscle-skeletal disorder affecting 80% of the population. It is very common in pregnancy, and acupuncture is a well know treatment for pregnant women searching for back pain relief. Aim: Demonstrate that it is possible to treat low back pain in pregnancy without using anti-inflammatory medications. Methods: M.T.F., female, 40, primiparous, 8-month pregnant. On January 30, 2013, her left leg began to hurt at the thigh near her buttocks, which made it difficult for her to walk. As it was the end of the afternoon, she assumed it was because she had not rested enough. She laid down, and when she tried to get up, she could not walk and the pain was very strong. The patient decided not to take any anti-inflammatory or pain medication, due to the pregnancy. She started a treatment with ancient medical tools, including acupuncture on January 31, 2013. In her first consultation, she entered the office with significant mobility difficulty, especially for walking. She was diagnosed with Kidney Yin and Yang deficiency and Blood deficiency, according to TCM. She then received the first session of auricular and scalp acupuncture. Due to her pain, she received scalp acupuncture seated, because she was on the third semester of pregnancy and had difficulty in laying down, on the left and right side of the scalp, using the motor are related to the lower limbs on TCM literature. On the very first session, there was significant improvement of the pain. She also received auricular acupuncture with apex ear bloodletting. Results: After the sixth session, she practically did not feel pain anymore. Conclusion: It is possible to treat low back pain in pregnancy without using any anti-inflammatory medication, according to this case report, preventing any harm associated with the medication use, on the baby formation.

Piroctone olamine (octopirox) has a wide spectrum of antibacterial activity against gram-positive and gram-negative pathogenic microorganisms together with the expressed antimycotic action. Octopirox is characterized by good tolerance and harmlessness and, also, deodorizing effect when applying topically. Besides, the composition of piroctone olamine with designed naphthalan in the formula of the ointment for external use should be perspective. Designed naphthalan is a natural ingredient with mineral nature and has desensitizing, anti-inflammatory, analgesic, reabsorbable, anti-itch, warming, and antibacterial effects. By the staff members of the department of Medicines Technology of Zaporizhzhia State Medical University a compositional formula of the ointment with piroctone olamine and designed naphthalan for topical therapy of patients with seborrheic dermatitis, accompanied by scalp damage, was proposed on the base of complex investigations. It is predicted that the administration of the developed pharmacotherapeutic agent should enhance the normalization of lipid mantle, keratinization, desquamation, overcoming itch, and skin inflammatory. The aim of this work is to study of impacts of thermal handling of the compositional trichological ointment on the hydrophilic base at temperature interval of the technological process of manufacturing this dosage form. Materials and methods. As objects of derivatografic investigations, the experimental ointment for topical administration and, also, active components (piroctone olamine, deresined naphthalan) and excipients of this ointment (sodium carboxymethylcellulose, glycerol, twin 80, propylene glycol) were used. Thermogravimetric analysis was carried out using derivatograph “Shimadzu DTG-60” (Japan) with the platinum and platinum-rhodium thermopair. Results. Data on thermogravimetric analysis clearly demonstrate the thermal stability of the active pharmaceutical ingredients and excipients in the investigating dosage form. Derivatograms of the ointment with piroctone olamine and it was hydrophilic vehicle-placebo show a matching of their thermal effects with the same of the active substance and excipients. That fact indicates the absence of chemical interactions between them. Conclusions. It was established that ingredients of the developed semisolid dosage form for topical therapy of seborrheic dermatitis with piroctone olamine on the hydrophilic base have not done interact with each other and, so, this composition has been a mechanical mixture of active substances and excipients. It was revealed that, according to thermal effects of the ingredients of the developed ointment for external use, the technological process of its manufacturing would be appropriate at a temperature below 90°С.

Background Pressure sore, bed sores, and decubitus ulcer have the same meaning and are used to describe ischemic tissue loss resulting from prolonged pressure over bony prominence. They can develop anywhere in the body, but often are located in the trochanteric, ischial, heel, and sacral areas. Although tissue destruction can occur over areas like the scalp, shoulders, calves, and heels when a patient is lying down, ischial sores occur in wheelchair-bound patients who are sitting, making ‘pressure sore’ the better term. Objectives The purpose of the study is to describe our experience in the management of sacral pressure sore with a gluteus maximus myocutaneous flap, its feasibility and outcome. Patients and methods Our prospective study has been conducted in the Surgery Department of Benha University Hospital from February 2017 to February 2019 on 20 patients treated with a unilateral gluteus maximus myocutaneous flap to reconstruct the presacral defect due to pressure sore and all patients have signed informed consents before they have been involved in this study. Results Gluteus maximus flap in presacral pressure sores is a highly feasible and effective method for the treatment of presacral pressure ulcer defect. It has been associated with short operative time (average 45 min) and small amounts of intraoperative blood loss (average 338 ml), three cases out of 20 showed postoperative hematoma, two cases developed wound dehiscence, two cases developed infection, one case developed partial flap necrosis, four cases developed pigmentation, two cases developed keloid, and only one case developed postoperative recurrence. Conclusion The gluteus maximus myocutaneous flap is a useful, safe, and versatile flap for the repair of presacral decubitus ulcer by a simple approach. It may be recommended as the procedure of choice for surgical treatment of this type of wound.

McCune-Albright syndrome (MAS) is one of the conditions causing precocious gonadotropin-independent puberty. It is a rare disease, characterized by two of the three following features: precocious puberty, polyostotic fibrous dysplasia (PFD), and café au lait (CAL) skin spots. Herein is presented the case of a girl with pubarche, acne, and transient thelarche since the age of three and menarche since the age of six years old. Besides transitory follicular cysts and advanced bone age, no other changes were found. Diagnosis was only established after brain magnetic resonance imaging showed fibrous dysplasia involving left craniofacial bones. The girl’s parents later mentioned that she had multiple café au lait skin spots on the scalp since birth, disclosing how the key diagnostic sign had been covered by the child’s hair. MAS is a rare disorder and diagnosis depends on a high index of suspicion. CAL skin spots are generally the first manifestation, but can easily go unnoticed. Additionally, PFD may only affect some bones, like craniofacial.

ABSTRACT Firstly, this paper establishes 5G mobile phone antenna and human head model. The performance characteristics of the two 5G mobile phone antennas were analyzed by HFSS（High Frequency Structure Simulator）software, and the electric field strength and specific absorption rate (SAR) distribution in the human head model under different antenna working frequency conditions were simulated. The simulation results show that: When the antenna operating frequency is 2600MHz, the average SAR of any adjacent tissue with a mass of 10g in the human head model is 0.217W/kg, the peak of the electric field strength is 21.067V/m, and the average frequency is 3500MHz, the peak of the specific absorption rate was 0.285 W/kg, and the peak of the electric field strength was 22.844 V/m. Conclusion: Most of the electromagnetic field is absorbed by the scalp and skull near the antenna side. The SAR value reaching the brain is about 0.25 times of the total SAR value. The electric field strength is similar to the SAR value. As the distance between the brain region and the antenna increases, The SAR value decreases, and the SAR value in the brain is about 0.125 times that of the scalp. Compared with the limits set by the International Commission on Non-Ionizing Radiation Protection (ICNIRP), it is lower than the public electromagnetic exposure limit value 2W/kg, which is in line with international standards.

Surgical craniotomy such as skin incisions, head pinning, periosteal-dural contact, dura closure, bones and skin can cause of nociceptive stimulation. These actions are stimuli to the nerves that can stimulate stress response. The stress response to surgery is characterized by increased secretion of the pituitary hormone and activation of the sympathetic nervous system. Hypothalamic activation of the sympathetic autonomic nervous system results in increased secretion of catecholamines from the adrenal medulla and the release of norepinephrine from the presynaptic nerve terminal. Objectives: This study is a single blind experimental, 14 patients with ages 18-60 years physical status ASA (American Society of Anesthesiologists) 1-3, with elective craniotomy surgery. This study was divided into two groups of subjects, group A with seven craniotomy subjects with general anesthesia and group B with seven craniotomy subjects combined with scalp block using ropivacaine 0.5%. Data collected then analyzed with SPSS. We found a decrease in MAP (Mean Arterial Pressure) and heart rate in the scalp block group during scalp incision (MAP p=0.002; HR p=0.029), periosteal contact (MAP p=0.025; HR p=0.039) significantly, as well as the use of fentanyl during surgery was significantly decreased (p=0.0001). General anesthesia with scalp block is more effective in reducing the increase in MAP, heart rate and fentanyl consumption during craniotomy.

Oral lichen planus (OLP) is an autoimmune, mucocutaneous disease involving oral mucosa, skin, scalp, genital mucosa and nails. It is the common skin diseases present in the oral cavity. An immune mediated reaction is recognized in lichen planus, but exact etiology is unknown. The disease mostly affects middle-aged females and is infrequently found in children. The atrophic and erosive forms of OLP are less common. Potential of OLP to malignancy is controversial. Although relatively, oral lichen planus is the target of controversy, mainly in relation to its pathogenesis and possible potential for malignancy. Hence it is essential for the clinicians to keep an index of suspicion for all intraoral lichenoid lesions. Periodic follow-up of patients with OLP is recommended.

Objective To explore the clinical effect of composite skin which was prepared by self-split-scar-tissue on repairing scar contracture deformity in functional site of severe burn children. Methods A total of 12 patients (7 males and 5 females)with age from 3 to 10 years were included in the group. All the patients were suffered from cicatricial contracture deformity after burn injury and admitted to Xijing Hospital of Air Force Medical University from March 2015 to March 2018. Scar contractures were located at the ankles, elbows, armpits and trunks. The scar adhesion contracture in the axilla resulted in the shoulder joint lifting movement at 30°-60°. Due to scar contracture, the angle of elbow joint elongation is only 45°-90°. Popliteal scar causes the knee joint to straighten at angle of 95°-110°. Scar contracture in the lateral chest and abdomen caused the ipsilateral nipple to move 5 cm downward, and the Central Line of standing position flexed to the affected side by about 20°.During operations, the cicatricial contracture was completely released, joint activity was restored, distortion organs were repositioned. After this, the secondary defect was formed, ranging from 5 cm×10 cm-11 cm×20 cm. The stable scar area (8 on the back and 6 on in the thigh) was chosen as donor site of thickness scar skin and the split thickness skin was harvested from scalp. The self-scar-tissue was taken from scar at a thickness of 0.5 mm and meshed at a ratio of 1∶1. The new composite skin was prepared by meshed self-scar-tissue as dermal matrix and split thickness skin as the cover. Then, the new composite skin was grafted on the secondary defect. Meanwhile, the split thickness scar-skin was replanted to the donor site after scar-dermal matrix had been harvested. The two surgical sites were routinely pressure-wrapped. The dressings were exchanged after 7-10 days to observe the skin graft survival and follow-up observation. Results In 12 patients, a total of 14 composite skin grafts were used in the repair area. The composite skin were all prepared according to the size and shape of defect (50 cm2 to 220 cm2) . Among them, 12 grafts survived well and 2 grafts caused partial skin necrosis due to infection (the two skin necrosis cases healed after dressing changing). The 14 split thickness scar-skins were all survived well on donor sites. A follow up from 2 to 24 months, the function and appearance of the ankles, elbows, armpits of the self-scar-tissue composite skin grafting and the donor site of split thickness scar-skin were both satisfactory. Postoperative elevation of shoulder joint contracture was 150°-170°. Elbow contracture patients can be basically straight, up to 170°-180°. Patients with knee contracture can be fully extended up to 180°. After the scar contracture of the side chest and abdomen was fully released, the affected side nipple returned to the normal position and the midline of standing position was basically normal. All the skin pieces in the replantation area of 14 scar epidermis survived well, and their appearance was not significantly different from that before surgery. The scalp donor area heals well without scar formation and hair loss. Conclusions This kind of novel composite skin can provide a hopeful method for the deformity recovery of severe burn children. Key words: Children; Burn; Cicatrix; Composite skin; Transplantation