Risk Of Skin Lesions Research Articles

Gastrointestinal Disorders and Atopic Dermatitis in Infants in the First Year of Life According to ROME IV Criteria-A Possible Association with the Mode of Delivery and Early Life Nutrition.

Background: Functional gastrointestinal disorders are very common condition. The aim of this study is to evaluate the implications of the mode of pregnancy termination and early infant feeding on the incidence of gastrointestinal disorders and atopic dermatitis at birth and 3, 6, and 12 months of age. Methods: This study included 82 pregnant women and their newborns born at term. All newborns were examined at birth and 3, 6, and 12 months of age according to the ROME IV criteria. Results: In children born after cesarean section, the incidence of regurgitation was significantly higher. In children fed mostly or exclusively with formula, dry skin with allergic features was observed more often compared to breastfed children, but this relation was statistically significant only at the age of 12 months. The use of antibiotic therapy increased the risk of allergic skin lesions by almost seven times at 3 months of life. Gastrointestinal disorders in the form of regurgitation, colic, and constipation occur within the period of up to 12 months of the child's life and may be related to the mode of the termination of pregnancy via cesarean section and the use of artificial feeding or antibiotic therapy. The occurrence of atopic dermatitis in infants at 12 months of life is correlated with the mode of the termination of pregnancy after cesarean section. Conclusions: One of the risk factors for the occurrence of atopic dermatitis and gastrointestinal disorders in the period up to 12 months of the child's life may be a cesarean section and the use of formula feeding or antibiotic therapy.

Skin lesions associated with invasive devices in highly complex neonatal and pediatric patients

The skin is the largest organ of the human body. It has three layers: epidermis, dermis and hypodermis. The epidermis performs multiple functions in the body, standing out as a defensive barrier and internal integrity in addition to containing the evasion of moisture, and exogenous substances. Injury is by definition any interruption in the continuity of the skin regardless of its extent and may be chronic or acute. A newborn's skin is delicate and vulnerable, and the use of invasive devices in highly complex care can negatively affect its integrity. This review study addressed data from Brazilian research on newborn skin in intensive hospital treatment units. The studies evaluated were obtained from the SciELO, Medline and Lilacs, Google Scholar and Elsevier databases. The inclusion criteria were articles, monographs, dissertations and theses published in the period between 2018 and 2023, in Portuguese with a pre-established theme, and the exclusion criteria were articles, monographs, dissertations and repeated theses, incomplete manuscripts and with unauthorized access free of charge. As results, 3 categories were obtained: Category 1 – Main causes of skin lesions in newborns and highly complex children. Category 2- Prevention measures in newborns and highly complex children with skin lesions. Category 3- Highly complex skin care strategies for newborns and children. It is evident that due to the high susceptibility of newborns and children to develop highly complex skin lesions, it requires greater attention from the nursing team. Early detection of the risk of skin lesions and the use of prophylaxis enable a better quality of life for newborns hospitalized in high complexity, avoiding and minimizing skin lesions caused by the care provided.

Identifying risk factors of anti-TNF induced skin lesions and other adverse events in paediatric patients with inflammatory bowel disease.

While higher infliximab (IFX) trough concentrations (TCs) are associated with better outcomes in patients with inflammatory bowel disease (IBD), they could pose a risk for adverse events (AEs), including IFX-induced skin lesions. Therefore, we studied correlations between IFX TCs and occurrence of AEs in paediatric IBD patients. In this single-centre study, all children with Crohn's disease (CD) and ulcerative colitis (UC) receiving IFX maintenance therapy who underwent proactive drug monitoring between March 2015 and August 2022 were included. IFX doses/intervals/TCs and patient characteristics were systematically registered, as well as AEs and skin lesions appearance. A total of 109 patients (72 CD and 37 UC) contributed 2913 IFX TCs. During a median follow-up of 3.0 [1.5-4.5] years, we observed 684 AEs in 101 patients and 49 skin lesions in 35 patients. There was no significant difference (p = .467) in median TCs between patients with and without skin lesions. However, higher median IFX doses were associated with an increased hazard rate of skin lesions [HR 1.084 (1.024-1.148), p = .005], in addition to female sex [2.210 (1.187-5.310), p = .016] and diagnosis of CD [1.695 (1.241-1.877), p = .011]. Considering IFX therapeutic TC cut-offs of 5.0 and 9.0 µg/mL, there was no significant difference in AE rate (p = .749 and p = .833, respectively). Also, no significant association between IFX doses and AE rate (p = .159). Increasing the IFX dose to achieve therapeutic TCs may not increase the overall risk of AEs in paediatric IBD patients. However, concerns arise regarding the risk of skin lesions, especially in female CD patients.

Congenital herpes simplex with ophthalmic and multisystem features: a case report

BackgroundNeonatal herpes simplex virus (HSV) infection is rare and has significant morbimortality rates. Approximately 85% of newborns are infected intrapartum, and risk factors for mother-to-child transmission include vaginal delivery, primary maternal infection, and prolonged rupture of membranes. Neonatal HSV can manifest with isolated mucocutaneous lesions, neurological involvement, or disseminated disease. In general, herpetic infection can cause blepharoconjunctivitis or keratitis. We report a rare case of congenital herpes with ophthalmologic manifestations and multisystemic involvement.Case presentationA preterm infant, born at 32 weeks and 2 days, with presumed neonatal infection developed intestinal and respiratory complications, as well as hyperemic lesions on the left nostril and oral mucosa. An ophthalmological assessment was requested and brought up the suspicion of HSV infection, indicating empirical treatment with endovenous acyclovir. Later, a new ocular examination was suggestive of panuveitis. Afterward, serum IgM antibodies to HSV-1 and HSV-2 were positive. Proper antiviral therapy led to an improvement in the condition.DiscussionNeonatal herpes is associated with a high risk of persistent skin lesions, long-term neurological disability and other lasting sequelae. It is essential to consider HSV infection in cases of neonatal conjunctivitis, especially in patients with an epithelial defect and no improvement after initial treatment with topical or systemic antibiotics.ConclusionsIn the management of neonatal HSV, early diagnosis is essential for the timely initiation of antiviral therapy. Our report highlights that ocular assessment can be crucial in the correct diagnostic investigation of this condition.

Assessing the health risks of coal-burning arsenic-induced skin damage: A 22-year follow-up study in Guizhou, China

Risk assessment of arsenic-induced skin damage has always received significant global attention. Theories derived from arsenic exposure in drinking water may not be applicable to the coal-burning type to arsenic-exposed area. Furthermore, very few studies have successfully determined the reference value of cumulative arsenic (CA) exposure that leads to specific skin lesions. In this study, we conducted a 22-year follow-up investigation to assess the risk of skin lesions and cancer resulting from long-term, multi-channel arsenic exposure from hazard identification, dose-response assessment, exposure assessment, and risk characterization. The results show that the arsenic exposure can significantly increase the prevalence of skin lesions. For each interquartile range increase of hair arsenic (HA) and CA, the risk of skin damage increased by 1.91 and 3.90 times, respectively. The lower confidence limit of the benchmark dose of HA of arsenic-induced various skin lesions ranged from 0.07 to 0.12 μg·g−1, and 932.57 to 1368.92 mg for CA. The chronic daily intake, lifetime average daily dose in the arsenic-exposed area after the comprehensive prevention and control measures have decreased significantly, but remained higher than the daily baseline level of 3.0 μg·kg−1·d−1. Even as recently as 2020, the hazard quotients and hazard index still exceeded 1, measuring 155.33 and 55.20, and the lifetime excess risk of skin cancer (2.80 × 10−3) remains significantly higher than the acceptable level of 10−6. Our study underscores the effectiveness of comprehensive prevention and control measures in managing high arsenic exposure in coal-burning arsenic poisoning areas. However, it is crucial to acknowledge that the risk of both non-carcinogenic and carcinogenic effects on the skin remains substantially higher than the acceptable level. We recommend setting reference limits for monitoring skin damage among individuals exposed to arsenic, with a recommended upper limit of 0.07 μg·g−1 for HA and a maximum acceptable level of 935.57 mg for CA.

Resiliency and Risk Assessment of Smart Vision-Based Skin Screening Applications with Dynamics Modeling

The prevalence of skin diseases remains a concern, leading to a rising demand for the advancement of smart, portable, and non-invasive automated systems and applications. These sought-after technologies allow for the screening of skin lesions through captured images, offering improved and accessible healthcare solutions. Clinical methods include visual inspection by dermatologists; computer-aided vision-based image analysis at healthcare settings; and, lastly, biopsy tests, which are often costly and painful. Given the rise of artificial intelligence-based techniques for image segmentation, analysis, and classification, there remains a need to investigate the resiliency of personalized smartphone (hand-held) skin screening systems with respect to identified risks. This study represents a unique integration of distinct fields pertaining to smart vision-based skin lesion screening, resiliency, risk assessment, and system dynamics. The main focus is to explore the dynamics within the supply chain network of smart skin-lesion-screening systems. With the overarching aim of enhancing health, well-being, and sustainability, this research introduces a new framework designed to evaluate the resiliency of smart skin-lesion-screening applications. The proposed framework incorporates system dynamics modeling within a novel subset of a causal model. It considers the interactions and activities among key factors with unique mapping of capability and vulnerability attributes for effective risk assessment and management. The model has been rigorously tested under various case scenarios and settings. The simulation results offer insights into the model’s dynamics, demonstrating the fact that enhancing the skin screening device/app factors directly improves the resiliency level. Overall, this proposed framework marks an essential step toward comprehending and enhancing the overall resiliency of smart skin-lesion-screening systems.

Application of Maggot Debridement Therapy on Infected Wounds of Newborns: A Case Series in Iran

Neonates hospitalized in the Neonatal Intensive Care Units (NICU) are exposed to a higher risk of iatrogenic skin lesions. Maggot Debridement Therapy (MDT) in recent years has gotten more attention as a debriding, and disinfecting agent. The aim of this study was to treat infants with infected wounds and to evaluate the effectiveness and safety of MDT on in this group of patients. The study was conducted on four infants (12 to 30 days old) with infected wounds who could not withstand surgical debridement. Lucilia sericata larvae were used along with other standard therapies. The result of this study showed that MDT is an effective biological debridement tool with a good safety margin amongst infants. It removes all the necrotic tissue and induced granulation after application. In addition, it shortens the healing time, reduced pain, and decreased the rate of antibiotic consumption thereby reducing the overall cost of management.

New AI-algorithms on smartphones to detect skin cancer in a clinical setting-A validation study.

The incidence of skin cancer is rising worldwide and there is medical need to optimize its early detection. This study was conducted to determine the diagnostic and risk-assessment accuracy of two new diagnosis-based neural networks (analyze and detect), which comply with the CE-criteria, in evaluating the malignant potential of various skin lesions on a smartphone. Of note, the intention of our study was to evaluate the performance of these medical products in a clinical setting for the first time. This was a prospective, single-center clinical study at one tertiary referral center in Graz, Austria. Patients, who were either scheduled for preventive skin examination or removal of at least one skin lesion were eligible for participation. Patients were assessed by at least two dermatologists and by the integrated algorithms on different mobile phones. The lesions to be recorded were randomly selected by the dermatologists. The diagnosis of the algorithm was stated as correct if it matched the diagnosis of the two dermatologists or the histology (if available). The histology was the reference standard, however, if both clinicians considered a lesion as being benign no histology was performed and the dermatologists were stated as reference standard. A total of 238 patients with 1171 lesions (86 female; 36.13%) with an average age of 66.19 (SD = 17.05) was included. Sensitivity and specificity of the detect algorithm were 96.4% (CI 93.94-98.85) and 94.85% (CI 92.46-97.23); for the analyze algorithm a sensitivity of 95.35% (CI 93.45-97.25) and a specificity of 90.32% (CI 88.1-92.54) were achieved. The studied neural networks succeeded analyzing the risk of skin lesions with a high diagnostic accuracy showing that they are sufficient tools in calculating the probability of a skin lesion being malignant. In conjunction with the wide spread use of smartphones this new AI approach opens the opportunity for a higher early detection rate of skin cancer with consecutive lower epidemiological burden of metastatic cancer and reducing health care costs. This neural network moreover facilitates the empowerment of patients, especially in regions with a low density of medical doctors. Approved and registered at the ethics committee of the Medical University of Graz, Austria (Approval number: 30-199 ex 17/18).

Multiple necrotizing skin lesions due to glatiramer asetate injection

Nicolau’s syndrome due to glatiramer acetate (GA) injection has been rarely reported. We report a 35-year-old woman with multiple sclerosis who presented with two necrotizing skin lesions due to consecutive subcutaneous GA injection. The patient was diagnosed with Nicolau’s syndrome and treated with wound care. The lesions regressed slowly with a mild scarring. We discontinued GA treatment because of the recurrence risk of skin lesions. We think the syndrome has a good prognosis with conservative treatment; however, discontinuation of GA may be necessary especially in case of multiple skin lesions.

Somatic loss of the Y chromosome is associated with arsenic exposure among Bangladeshi men.

Arsenic exposure increases the risk of several cancers in humans and contributes to genomic instability. Somatic loss of the Y chromosome (LoY) is a potential biomarker of genomic instability and cancer risk. Smoking is associated with LoY, but few other carcinogens have been investigated. We tested the cross-sectional association between arsenic exposure and LoY in leukocytes among genotyped Bangladeshi men (age 20-70 years) from the Health Effects of Arsenic Longitudinal Study. We extracted the median of logR-ratios from probes on the Y chromosome (mLRR-chrY) from genotyping arrays (n = 1364) and estimated the percentage of cells with LoY (% LoY) from mLRR-chrY. We evaluated the association between arsenic exposure (measured in drinking water and urine) and LoY using multivariable linear and logistic regression models. The association between LoY and incident arsenic-induced skin lesions was also examined. Ten percent of genotyped men had LoY in at least 5% of cells and % LoY increased with age. Among men randomly selected for genotyping (n = 778), higher arsenic in drinking water, arsenic consumed and urinary arsenic were associated with increased % LoY (P = 0.006, P = 0.06 and P = 0.13, respectively). LoY was associated with increased risk of incident skin lesions (P = 0.008). Arsenic exposure was associated with increased LoY, providing additional evidence that arsenic contributes to genomic instability. LoY was associated with developing skin lesions, a risk factor for cancer, suggesting that LoY may be a biomarker of susceptibility in arsenic-exposed populations. The effect of arsenic on somatic events should be further explored in cancer-prone tissue types.

Abstract 1440: Identifying inherited genetic variation that impacts individuals’ ability to metabolize arsenic and susceptibility to toxicity

Abstract Inorganic arsenic (iAs) is a class I human carcinogen, and exposure to iAs affects >200 million individuals worldwide. In Bangladesh, >57 million individuals are chronically exposed to iAs through drinking-water. There is inter-individual variation in arsenic metabolism efficiency (AME) due to inherited genetic variation, and this variability impacts individuals’ internal dose of arsenic and their susceptibility to toxicity. Identifying genetic determinants of AME to help identify individuals at higher risk for toxicity has been a focus within genetic epidemiology research. Consumed arsenic enters the blood in as iAs. Sequential reduction and methylation reactions are catalyzed by glutathione and arsenic methyltransferase (AS3MT) respectively, producing monomethylated (MMA) and dimethylated (DMA) forms of arsenic. Generation of DMA is beneficial because DMA is more easily expelled from the body in urine compared to MMA or iAs. AME is often represented by the percent of the arsenic species in urine that exists as DMA. Previous studies have identified genetic variants in the AS3MT (10q24.32) and FTCD (21q22.3) regions as showing clear association with AME. However, additional regions containing variants showing robust and replicable association with AME have not yet been identified, although studies of AME heritability suggest that additional variants are likely to exist. We used data from >7,000 participants from two studies of Bangladesh individuals with varying levels of exposure to arsenic through drinking water (The Health Effects of Arsenic Longitudinal Study, HEALS, and the Bangladesh Vitamin E and Selenium Trial, BEST) to identify genetic variation that impacts individuals’ ability to metabolize arsenic and their susceptibility to toxicity (i.e., arsenic-induced skin lesions). Our preliminary results suggest novel associations with AME in the 1q24.3 region (p= 5.16 x10-14) and with skin lesion risk in the 6p21.33 region (p=1.37x10-9). The identified variants in the 1q24.3 region reside in and around the FMO3 gene. FMOs are enzymes involved in xenobiotic metabolism; therefore, it is plausible that they may play a role in arsenic metabolism. The 6p21.33 signal is in the major histocompatibility complex (MHC) region, which contains numerous key immune response genes (e.g., HLA genes). These results suggest the existence of additional variants associated with AME and arsenic toxicity risk. Citation Format: Lizeth I. Tamayo, Lin Tong, Muhammad G. Kibriya, Farzana Jasmine, Habibul Ahsan, Brandon L. Pierce. Identifying inherited genetic variation that impacts individuals’ ability to metabolize arsenic and susceptibility to toxicity [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1440.

Bullous skin lesions in cirrhotic patients receiving combination of terlipressin and noradrenaline: a case series

Background and Aim: Effect of terlipressin on systemic circulation causing severe ischemic events like myocardial ischemia, ischemic colitis and skin necrosis are rare. We present a case series of four patients, who developed blistering skin disease after administration of combination of Terlipressin and noraenalin both. We aimed to look for risk factors, onset, progress and outcome of bullous skin lesions in cirrhotic patients receiving combination of Terlipressin and Noradrenaline. Methods: We have included patients of liver cirrhosis who were started on Terlipressin for hepato-renal syndrome or variceal bleeding with Noradrenaline for shock and developed skin blisters. Results: Series includes four middle aged male patients of cirrhosis of liver with three patients had alcohol and one patient had NASH as etiology. Three patients had septic shock with HRS, while one had massive variceal bleed with hypotension. All four developed blistering within 2-4 days of starting vasopressors. Terlipressin was given in intravenous bolus doses (1 mg thrice to four times a day) while noradrenaline was given as infusion. Blisters were common in extremities, were extensive, and one even progressed to ischemic necrosis of skin. Blistering was more extensive with higher doses of terlipressin and noradrenaline. Sepsis as etiology for blisters was excluded in all by testing the fluid within the bullous lesion and negative blood cultures. Terlipressin was stopped in all, after which eruption of new lesions halted and skin lesions healed completely. Conclusions: Risk of bullous skin lesion increases when terlipressin is given as bolus doses as compared to infusion , when used in higher doses and in combination with noraenalin. In addition to the obesity, NAFLD, and ischemic heart disease, it was important to think that alcohol use was a possible risk factor for progressive ischemic necrosis due to terlipressin. Majority of patient’s skin lesions recovers after stopping terlipressin.

Integrating Domain Knowledge into Deep Learning for Skin Lesion Risk Prioritization to Assist Teledermatology Referral.

Teledermatology has developed rapidly in recent years and is nowadays an essential tool for early diagnosis. In this work, we aim to improve existing Teledermatology processes for skin lesion diagnosis by developing a deep learning approach for risk prioritization with a dataset of retrospective data from referral requests of the Portuguese National Health System. Given the high complexity of this task, we propose a new prioritization pipeline guided and inspired by domain knowledge. We explored automatic lesion segmentation and tested different learning schemes, namely hierarchical classification and curriculum learning approaches, optionally including additional patient metadata. The final priority level prediction can then be obtained by combining predicted diagnosis and a baseline priority level accounting for explicit expert knowledge. In both the differential diagnosis and prioritization branches, lesion segmentation with 30% tolerance for contextual information was shown to improve classification when compared with a flat baseline model trained on original images; furthermore, the addition of patient information was not beneficial for most experiments. Curriculum learning delivered better results than a flat or hierarchical approach. The combination of diagnosis information and a knowledge map, created in collaboration with dermatologists, together with the priority achieved interesting results (best macro F1 of 43.93% for a validated test set), paving the way for new data-centric and knowledge-driven approaches.

The Influence of the Use of Face Masks During the COVID-19 Pandemic on the Human Microbiome – A Mini-Review

The aim of this study was to draw attention to the possible consequences of improper, unhygienic use of mouth and nose covers in the context of prophylaxis against the spread of COVID-19 from the point of view of a family physician and focus on the risk of respiratory infections and skin lesions in patients, in different age groups. The use of protective masks may reduce the likelihood of infection but will not eliminate the risk of infection. However, it should be remembered that any mask, no matter how effective the filtration is or how well it seals, will have little effect if not used in conjunction with other preventive measures, including isolation of infected people, immunization, proper respiratory culture, regular, frequent replacement of masks, and hand hygiene. Additionally, certain risks associated with this form of prophylaxis should be taken into account, which, unfortunately, may also aggravate or even constitute a source of serious respiratory infections and lead to the development and aggravation of skin problems. Moreover, educating society not only on hand hygiene but also on the topic of the value of nose and mouth covers, as well as the frequency of their replacement and/or disinfection, is becoming a significant issue.

The relatively higher concentrations of trace elements to arsenic may have influenced on methylation process of inorg- As in humans

The relatively higher concentrations of trace elements to arsenic may have influenced on methylation process of inorg- As in humans

Nutrition, one-carbon metabolism and arsenic methylation

Exposure to arsenic (As) is a major public health concern globally. Inorganic As (InAs) undergoes hepatic methylation to form monomethyl (MMAs)- and dimethyl (DMAs)-arsenical species, facilitating urinary As elimination. MMAsIII is considerably more toxic than either InAsIII or DMAsV, and a higher proportion of MMAs in urine has been associated with risk for a wide range of adverse health outcomes. Efficiency of As methylation differs substantially between species, between individuals, and across populations. One-carbon metabolism (OCM) is a biochemical pathway that provides methyl groups for the methylation of As, and is influenced by folate and other micronutrients, such as vitamin B12, choline, betaine and creatine. A growing body of evidence has demonstrated that OCM-related micronutrients play a critical role in As methylation. This review will summarize observational epidemiological studies, interventions, and relevant experimental evidence examining the role that OCM-related micronutrients have on As methylation, toxicity of As, and risk for associated adverse health-related outcomes. There is fairly robust evidence supporting the impact of folate on As methylation, and some evidence from case-control studies indicating that folate nutritional status influences risk for As-induced skin lesions and bladder cancer. However, the potential for folate to be protective for other As-related health outcomes, and the potential beneficial effects of other OCM-related micronutrients on As methylation and risk for health outcomes are less well studied and warrant additional research.

Rare, Protein-Altering Variants in AS3MT and Arsenic Metabolism Efficiency: A Multi-Population Association Study.

Background:Common genetic variation in the arsenic methyltransferase (AS3MT) gene region is known to be associated with arsenic metabolism efficiency (AME), measured as the percentage of dimethylarsinic acid (DMA%) in the urine. Rare, protein-altering variants in AS3MT could have even larger effects on AME, but their contribution to AME has not been investigated.Objectives:We estimated the impact of rare, protein-coding variation in AS3MT on AME using a multi-population approach to facilitate the discovery of population-specific and shared causal rare variants.Methods:We generated targeted DNA sequencing data for the coding regions of AS3MT for three arsenic-exposed cohorts with existing data on arsenic species measured in urine: Health Effects of Arsenic Longitudinal Study (HEALS, ), Strong Heart Study (SHS, ), and New Hampshire Skin Cancer Study (NHSCS, ). We assessed the collective effects of rare (allele frequency ), protein-altering AS3MT variants on DMA%, using multiple approaches, including a test of the association between rare allele carrier status (yes/no) and DMA% using linear regression (adjusted for common variants in 10q24.32 region, age, sex, and population structure).Results:We identified 23 carriers of rare-protein-altering AS3MT variant across all cohorts (13 in HEALS and 5 in both SHS and NHSCS), including 6 carriers of predicted loss-of-function variants. DMA% was 6–10% lower in carriers compared with noncarriers in HEALS [ (95% CI: , )], SHS [ (95% CI: , )], and NHSCS [ (95% CI: , )]. In meta-analyses across cohorts, DMA% was 8.7% lower in carriers [ (95% CI: , )].Discussion:Rare, protein-altering variants in AS3MT were associated with lower mean DMA%, an indicator of reduced AME. Although a small percentage of the population (0.5–0.7%) carry these variants, they are associated with a 6–10% decrease in DMA% that is consistent across multiple ancestral and environmental backgrounds. https://doi.org/10.1289/EHP8152

Hydroa Vacciniforme-Like Lymphoproliferative Disorder in Korea: Prognostic Implication of Clinical Signs and Whole Blood Epstein-Barr Virus DNA.

BackgroundHydroa vacciniforme-like lymphoproliferative disorder (HVLPD) is rare Epstein-Barr virus (EBV)-associated disease. The classic form of HVLPD is a self-resolving disease, whereas the systemic form can progress to malignant lymphoma, resulting in fatal outcomes. However, the prognostic factors remain unclear.ObjectiveThis study aimed to evaluate the clinical characteristics of HVLPD and the association between whole blood EBV DNA and clinical outcomes.MethodsWe retrospectively reviewed our 25-year experience involving 11 patients with HVLPD from a single tertiary center in South Korea and evaluated the clinical characteristics of HVLPD and the correlation between whole blood EBV DNA and clinical outcomes.ResultsOf the total 11 patients, 54.5% (6/11) manifested classic HVLPD that resolved with conservative treatment, while 45.5% (5/11) patients had systemic HVLPD, four of whom died of progressive disease or hemophagocytic syndrome. Five patients with systemic HVLPD manifested severe skin lesions such as prominent facial edema, deep ulcers and necrotic skin lesions involving sun-protected areas. Median EBV DNA levels at initial diagnosis were higher in three dead patients than in those alive (2,290 vs. 186.62 copies/µl).ConclusionWhen EBV DNA levels were high, patients showed severe skin lesions and when EBV DNA levels were low, skin lesions tended to improve. Thus, patients with high EBV DNA levels showed an increased risk of severe skin lesions and disease progression.

Sun Exposure during Water Sports: Do Elite Athletes Adequately Protect Their Skin against Skin Cancer?

Excessive sun exposure is the main avoidable cause of skin cancer. Outdoor sports performed without adequate photoprotection are risky practices in this respect. This study examines whether elite athletes in water sports (specifically surfing, windsurfing, and sailing) take appropriate measures to protect their skin from the sun, and whether there are differences in this respect according to age, gender, or sports discipline. This study is based on a questionnaire-based health survey. World championship competitors completed a self-administered questionnaire on their sun protection and exposure habits, as well as sunburns during the last sports season. In total, 246 participants, with an age range of 16–30 years, completed the questionnaire. Of these, 49.6% used inadequate sun protection. Those who protected their skin appropriately tended to be older than those who did not (average age = 23.28 and 20.69 years, respectively; p = 0.000). There were no significant differences in sun protection habits between male and female athletes. The rate of sunburn was very high (76.7%). A high proportion (22.5%) of participants never used sunscreen. Elite athletes in water sports are at real risk of skin lesions from overexposure to the sun, associated with inadequate photoprotection practices. Campaigns to raise awareness and to promote the early detection of skin cancer should target these risk groups.

Continuous EEG monitoring by a new simplified wireless headset in intensive care unit

BackgroundIn critically ill patients continuous EEG (cEEG) is recommended in several conditions. Recently, a new wireless EEG headset (CerebAir®,Nihon-Kohden) is available. It has 8 electrodes, and its positioning seems to be easier than conventional systems.Aim of this study was to evaluate the feasibility of this device for cEEG monitoring, if positioned by ICU physician.MethodsNeurological patients were divided in two groups according with the admission to Neuro-ICU (Study-group:20 patients) or General-ICU (Control-group:20 patients). In Study group, cEEG was recorded by CerebAir® assembled by an ICU physician, while in Control group a simplified 8-electrodes-EEG recording positioned by an EEG technician was performed.ResultsTime for electrodes applying was shorter in Study-group than in Control-group: 6.2 ± 1.1′ vs 10.4 ± 2.3′; p < 0.0001. Thirty five interventions were necessary to correct artifacts in Study-group and 11 in Control-group. EEG abnormalities with or without epileptic meaning were respectively 7(35%) and 7(35%) in Study-group, and 5(25%) and 9(45%) in Control-group;p > 0.05. In Study-group, cEEG was interrupted for risk of skin lesions in 4 cases after 52 ± 4 h. cEEG was obtained without EEG technician in all cases in Study-group; quality of EEG was similar.ConclusionsAlthough several limitations should be considered, this simplified EEG system could be feasible even if EEG technician was not present. It was faster to position if compared with standard techniques, and can be used for continuous EEG monitoring. It could be very useful as part of diagnostic process in an emergency setting.