Rash Research Articles

Clinical features of drug reaction with eosinophilia and systemic symptoms: A retrospective study in a reference centre of dermatology in Madagascar

AbstractBackgroundDrug reaction with eosinophilia and systemic symptoms (DRESS) is drug‐induced hypersensitivity reaction that can have fatal complications. Three sets of diagnostic criteria have been proposed, however, consensus is lacking.ObjectivesThis study aimed to describe the causative agents, severity, and the clinical course of patients with DRESS in Antananarivo, Madagascar.MethodsA cross‐sectional study was conducted in patients seen for DRESS, in the department of dermatology at the University Hospital Antananarivo, Madagascar from 2014 to 2022. European Registry of Severe Cutaneous Adverse Reactions (RegiSCAR) criteria was used for the diagnosis. Demographic data, latency periods, clinical and laboratory findings, culprit drugs, and outcomes were assessed.ResultsA total of 24 patients were included. Fifteen patients were female. The three most common culprit drugs were carbamazepine (17 patients), phenobarbital (2 patients), and ampicilline (2 patients). Median onset time (interquartile range) was 20 days (range: 7–62 days). Skin rash was present in all patients, and fever in 18 patients. A total of 12 patients showed two or more internal organs involved. Liver and kidney injuries were the most common visceral manifestation. All patients had eosinophilia. Fifteen patients received systemic corticosteroids. Two mortality cases were reported due to DRESS‐related fulminant liver failure and to nosocomial respiratory infection. Mortality was associated with higher eosinophilia (p = 0.03), higher creatininemia (p = 0.04), and shorter time of latency (p = 0.04).ConclusionsOur study show that DRESS is associated with severe morbidity. Early detection and withdrawal of the culprit dru gis crucial to save life and reduce morbidity.

OA34 Unravelling the role of B cells and interferon dysregulation in juvenile dermatomyositis

Abstract Background/Aims Juvenile dermatomyositis (JDM) is a rare childhood autoimmune disease, characterised by muscle inflammation and skin rash. At present, the exact mechanisms driving JDM pathogenesis remain unclear. Recent investigations have focused on the potential roles of interferon (IFN) dysregulation and B cells. This study aims to explore alterations in B cell populations and their association with disease severity and IFN pathway dysregulation in JDM patients. Methods Transcriptomic, flow cytometry, and clinical data were gathered from a cohort of 61 JDM patients recruited from the UK JDCBS. Clinical demographics and disease variables were extracted from the JDCBS database. Flow cytometry was utilised to examine B cell populations in treatment naïve (‘pre-treatment’ n = 48) and JDM patients on steroids and conventional DMARD treatment, including rituximab (on-treatment n = 24), in parallel with age-matched healthy donors (n = 35). Transcriptomic analysis was performed on the total CD19+ B cells to assess their gene expression profiles in JDM patients. Pathway enrichment analysis was applied to identify the involvement of IFN-related pathways in JDM pathogenesis. Results Flow cytometry analysis revealed a significant expansion of total B cells, (defined as CD19+, p < 0.0001, ANOVA) and immature B cells (defined as CD19+ CD24hi CD38hi, p = 0.0416, Kruskal-Wallis) in pre-treatment JDM patients compared to healthy controls, which returned to levels similar to those in healthy donors in on-treatment JDM patients. An inverse relationship between total B cells and the Childhood Myositis Assessment Scale (CMAS), a measure of muscle strength, was observed in pre-treatment JDM patients, indicating a connection between the expanded B cell population and worse disease. Transcriptomic analysis of B cells illustrated distinctive clustering between pre-treatment JDM patients and healthy controls, based on their type I IFN gene expression profiles. Pathway enrichment analysis confirmed the significant enrichment of IFN-related pathways in B cells of pre-treatment JDM patients. Conclusion This study validates previous observations (Piper et al., 2018) supporting a significant role of B cells in the pathogenesis of JDM and their association with IFN dysregulation. Notably, pre-treatment JDM patients exhibited an expansion of the total B cell population, and of immature B cells, which correlated with disease activity and were restored to normal levels with treatment. Transcriptomic analysis identified distinct IFN-related gene profiles in B cells from pre-treatment JDM patients. These findings offer valuable insights into the complex autoimmune condition of JDM, potentially opening avenues for novel therapeutic strategies. Disclosure A.E.K. Syntakas: None. H.D. Nguyen: None. R. Restuadi: None. B.R. Jebson: None. V. Alexiou: None. L.R. Marshall: None. E. Ralph: None. K. O’Brien: None. D. Cancemi: None. H. Peckham: None. A. Radziszewska: None. N. De Gruijter: None. G.T. Hall: None. S. Castellano: None. C. Ciurtin: None. C.T. Deakin: None. E. Rosser: None. L.R. Wedderburn: None. M. Kartawinata: None. M.G.L. Wilkinson: None.

Analysis and prediction of nutritional outcome of patients with pediatric inflammatory bowel disease from Bahrain

BackgroundInflammatory bowel disease (IBD) is a chronic gastrointestinal disease that causes anorexia, malabsorption, and increased energy requirements. Childhood IBD can significantly impact nutritional status and future health.ObjectiveThis study aimed to analyze the nutritional status of patients with pediatric IBD at presentation and during follow-up and to identify predictors of nutritional outcome.MethodsThis retrospective cohort study reviewed the medical records of children diagnosed with IBD in the Pediatric Department, Salmaniya Medical Complex, Bahrain, 1984 − 2023. Demographic data, clinical characteristics, and anthropometric data were collected. World Health Organization growth standards were used to interpret nutritional status.ResultsOf the 165 patients, 99 (60%) had anthropometric data at presentation, and 130 (78.8%) had follow-up data. Most patients were males (64.6%) and had Crohn’s disease (CD) (56.2%), while 43.8% had ulcerative colitis (UC). The median age at presentation was 10.9 years and the mean follow-up duration was 12.6 years. At presentation, 53.5% of the patients were malnourished, that decreased to 46.9% on follow-up. Thinness was reduced from 27.3% at presentation to 12.1% at follow-up (p = 0.003). There was an increased tendency to normal weight on follow-up (59.6%) compared to time of presentation (46.5%), p = 0.035. Overweightness showed a non-significant increase from 26.3% at presentation to 28.3% at follow-up (p = 0.791). Children with IBD were more likely to become obese when they grow up to adulthood (2.3% versus 20.5%, respectively, p < 0.001). Weight-for-age, and height-for-age at presentation were higher among CD compared to UC, but body mass index (BMI) at follow-up was higher among UC patients (p < 0.05). Thinness at follow up was associated with very early-onset disease (p = 0.02), lower weight and BMI at presentation (p < 0.001 each), younger age at follow-up (p = 0.002), pediatric age group (p = 0.023), lower hematocrit (p = 0.017), and higher C-reactive protein (p = 0.007). Overweight at follow up was associated with increased weight and BMI at presentation (p < 0.001 each), longer disease duration (p = 0.005), older age (p = 0.002), and azathioprine intake (p = 0.026). Considering follow-up duration, univariate analysis exhibited that Bahraini nationality, post-diagnosis disease duration, age at follow-up, occurrence of diarrhea, height, and BMI at presentation were factors that decreased liability to abnormal nutritional status, while CD, history of weight loss, perianal disease, and skin rash, and intake of prednisolone expressed increased liability of abnormal nutritional status (p < 0.05).ConclusionPediatric IBD is associated with a high incidence of malnutrition. Thinness is more prominent at presentation, while overweight is higher on follow-up. Multiple risk factors aggravating abnormal nutritional status were highlighted. Accordingly, nutritional counseling should be prioritized in a multidisciplinary approach.

Expert opinion on the prescription practice of topical calamine lotion for chronic urticaria and other dermatologic conditions in Indian clinical settings

Background: Calamine is suggested as a potentially effective treatment for skin exudation, itching, and rashes. However, there aren't many thorough analyses of the drug prescription patterns for treating urticaria in the Indian literature. This study aimed to gather expert opinions on the prescription practice of topical calamine lotion for chronic urticaria and other dermatologic conditions in Indian clinical settings. Methods: The cross-sectional questionnaire-based survey, comprising 25 questions, gathered data regarding the prescription practice of topical calamine lotion for the management of chronic urticaria and other dermatological conditions. Results: Of the 467 participants, 62% indicated that they would prescribe topical calamine lotion for pruritus management. About 39% of the participants preferred the cream formulation of the calamine lotion for treating diaper dermatitis in 11-25% of patients. About 76% of the respondents stated that they would recommend an oral antihistamine along with topical calamine lotion to treat chronic urticaria. For the treatment of pruritus, 44% of the participants preferred menthol in addition to calamine. Sixty-eight per cent of the respondents stated that approximately 5% of those with chronic urticaria need to be treated with calamine and tetrahydrocurcumin. Most specialists (69.38%) preferred using calamine lotion on 5-10% of patients with itchy skin conditions during pregnancy. Conclusions: Experts recommend the topical calamine lotion for managing various skin conditions including pruritus and chronic urticaria. Specialists recommended it as a safe option for managing itchy skin conditions during pregnancy.

P015 Nodular skin rash associated with relapsing polychondritis, a challenging diagnostic journey to VEXAS syndrome

Abstract Background/Aims VEXAS syndrome, first described in 2020, is a haemato-inflammatory disease caused by a mutation in the gene-UBA1.This syndrome can coexist with or without Myelodysplastic syndrome. What makes this case interesting is its long and challenging diagnostic journey and the involvement of different clinical specialties such as dermatology, ophthalmology, rheumatology, respiratory, haematology, and stroke teams. Ultimately, two years after the initial presentation, this appeared to be the first case of VEXAS with confirmed genetic mutation in the region. VEXAS being a relatively new entity, treating clinician/s were not aware of the possibility initially. Therefore, spreading awareness regarding the clinical picture of VEXAS is prudent. This case report highlights rheumatological and dermatological manifestations of the disease to aid in the timely diagnosis and management of future cases. Methods We report a 74-year-old previously healthy male presented in 2021 with a rash on his legs, arms, and torso since October 2019. It was progressive, painful, palpable, erythematous, non-pruritic, intermittent rash, cleared with hyperpigmentation. He also had oligoarticular arthritis, constitutional symptoms, recurrent episodes of polychondritis, uveitis, bibasal lung fibrosis, and an ESR and CRP above 100. He also had lymphadenopathy above the diaphragm, but the biopsy only showed necrotic material, and the bone marrow biopsy did not show any features of haematological malignancy. After excluding infections, he was started on high-dose oral prednisolone for relapsing polychondritis. The skin and inflammatory markers improved immediately following high doses of steroids. However, whenever steroids were weaned down, even with the help of Methotrexate, his skin was flaring. He also had unprovoked DVT and, while on anticoagulation, developed occipital infarction. He had extensive skin involvement when he had to stop Methotrexate following a chest infection. Results The skin biopsy was inconclusive. There was no significant cytopenia but persistent macrocytosis even after stopping Methotrexate. As a result, he underwent a repeat bone marrow biopsy, which showed Vacuoles and gene UBA1 mutation in 2023. Conclusion The heterogeneity and complexity of the disease are due to multi-organ involvement, including skin, joints, eyes, lungs, blood vessels, and cartilage, simultaneously or cumulatively. Skin involvement in VEXAS can also be vast, ranging from neutrophilic dermatosis, erythema nodosum-like lesions, leukocytoclastic, or urticarial vasculitis. Cutaneous manifestations develop in the majority with VEXAS syndrome and can be the first presenting symptom in this new rare syndrome. Disclosure M. Gunawardena: None. L. Yalakki: None. R. Moitra: None. E.L. Williams: None. H. Wong: None. D. D'Cruz: None.

Longitudinal study of patients with anti-SAE antibody positive dermatomyositis: a multicenter cohort study in China.

To describe the longitudinal study and long-term prognosis of multicentre large inception cohort of patients with anti-SAE positive DM. We retrospectively recruited patients with anti-SAE+DM in four tertiary referral centers from China between March 2005 and December 2022. Long-term survival analysis was performed in the enrolled patients. The Myositis Damage Index (MDI) and Cutaneous Disease Area and Severity Index (CDASI) were used to evaluate the degree of different organ damage and the extent of skin rashes. Longitudinal computed tomographic (CT) patterns were analyzed. Phenotypes were characterized using unsupervised cluster analysis. All-cause death occurred in 10.5% (4/38) of all patients, in which three patients succumbed to malignancies at 13, 18, and 36 months. Most patients had favorable long-term outcomes, 35.3% of them were in drug-free remission. Skin rashes showed significant improvement evaluated by CDASI with time. However, damage to different systems was observed in 70.6% of the surviving patients using the MDI, which mainly consisted in skin damage, accounting for 47.1%. Nine patients with anti-SAE+DM associated interstitial lung disease (ILD) underwent repeat CT showed marked radiological improvement at 6 months or being stable after 12 months. In further, different characteristics and outcomes were also showed in three clusters identified by unsupervised analysis. Anti-SAE+DM is characterized with lower mortality rate and the development of malignancies being the primary cause of death. Patients who survived showed notable cutaneous damage, while the ILD tends to stabilize. Clusters identified with unsupervised analysis could assist physicians in identifying higher risk of mortality.

A Meta heuristic based deep learning classifier for effective dengue disease prediction in IoT‐Fog system

AbstractThe primary aim of this article is to propose an effective dengue disease monitoring system by integrating deep learning models with Internet of Things (IoT) and fog computing. In this context, the disease related parameters are collected using IoT devices and further, the reports are securely transmitted to the healthcare facilities utilizing fog computing. In this article, the misdiagnosis error is reduced utilizing attention based long short term memory (ALSTM) network with coati optimization algorithm (COA). The Attention model allocates higher weight to significant parameters and pay additional consideration while training the model. Therefore, the conventional LSTM network is combined with a self‐attention mechanism for enabling this model to focus on relevant parts of the input sequences for precise dengue disease prediction. The Attention Model differs from the conventional model since it delivers higher amount of data into the decoder and improves additional stages to the attention decoder before making its output. Furthermore, the COA is integrated with the ALSTM network for optimal hyper‐parameter selection. The ALSTM‐COA model evaluates the dengue related parameters like nausea, vomiting, skin rash, joint pain, muscle pain, soft bleeding, temperature of water‐sites, humidity of water‐sites, and so forth, for timely dengue disease diagnosis and clinical decision‐making. The experiments performed on a real time dataset state that the ALSTM‐COA model achieves significant prediction results by utilizing different performance measures like recall, accuracy, fall‐out, miss rate, training time, and testing time. The ALSTM‐COA model obtains an accuracy of 99.27%, latency of 0.03 s, and time complexity of 8 s for 500 health records, which are superior to the comparative deep learning models.

A randomized controlled trial on the effect of early eschar dermabrasion combined with antimicrobial soft silicone foam dressing in the treatment of deep partial-thickness burn wounds in children

Objective: To explore the effect of early eschar dermabrasion combined with antimicrobial soft silicone foam dressing (hereinafter referred to as foam dressing) in treating the deep partial-thickness burn wounds in children. Methods: This study was a randomized controlled trial. From June 2021 to December 2022, 78 pediatric patients with deep partial-thickness burns who met the inclusion criteria were admitted to the Department of Burns in Guiyang Steel Plant Employees Hospital. According to the random number table, the pediatric patients were divided into two groups, with 38 cases left in combined treatment group (with 20 males and 18 females, aged 26.00 (16.75, 39.75) months) and 39 cases in foam dressing group (with 21 males and 18 females, aged 19.00 (14.00, 31.00) months) after the exclusion of one dropped-out child in follow-up. The pediatric patients in combined treatment group underwent eschar dermabrasion of the wound within 48 hours after injury, the wound was covered with foam dressing after operation, and the dressing was replaced once every 7 days; for the pediatric patients in foam dressing group, the wound was sterilized within 48 hours after injury and covered with foam dressing, and the dressing was replaced once every 2 to 3 days. After the wound healing, the children in both groups were routinely applied with silicone gel twice a day for 3 weeks before started wearing elastic sleeves for more than 18 hours a day, and continuously for over than 6 months. The degree of pain during dressing change was evaluated using the children's pain behavior inventory FLACC. The adverse reactions during the treatment period, number of dressing changes, and wound healing time were observed and recorded. Six months after wound healing, the Vancouver scar scale (VSS) was used to evaluate the condition of the wound scar. Results: When changing dressing, the FLACC score for pain of pediatric patients in combined treatment group was 3.5 (2.0, 5.0), which was significantly lower than 6.0 (5.0, 8.0) in foam dressing group (Z=-5.40, P<0.05). During the treatment period, no adverse reactions such as wound edema, fluid accumulation, or peripheral skin rash allergies occurred in any pediatric patient in both groups. The number of dressing changes of pediatric patients in combined treatment group was 3 (3, 4) times, which was significantly less than 8 (7, 10) times in foam dressing group (Z=-7.58, P<0.05). The wound healing time of pediatric patients in combined treatment group was (19±5) days, which was significantly shorter than (25±6) days in foam dressing group (t=-4.48, P<0.05). Six months after wound healing, the VSS score for scar of pediatric patients in combined treatment group was 5 (2, 8), which was significantly lower than 7 (5, 10) in foam dressing group (Z=-3.05, P<0.05). Conclusions: Compared with using foam dressings alone, early eschar dermabrasion combined with foam dressings can reduce the number of dressing changes, alleviate the pain during dressing changes, and shorten the wound healing time in treating children with deep partial-thickness burns, and effectively alleviate scar hyperplasia by combining with anti-scar treatment post burns.

A practical guide for the use of apalutamide for non-metastatic castration-resistant prostate cancer in Australia.

Studies of patients with castrate-resistant prostate cancer at high risk of developing overt metastases but with no current evidence of evaluable disease on computed tomography or bone scan non-metastatic castrate-resistant prostrate cancer have demonstrated increased metastasis-free survival and overall survival following treatment with the next-generation oral anti-androgen apalutamide (in addition to therapies that aim to lower testosterone to castrate levels) or luteinizing hormone-releasing hormone antagonist or surgical castration. Patients receiving apalutamide can be managed by medical oncologists, radiation oncologists, or urologists, preferably as part of a multidisciplinary team. However, the importance of additional safety monitoring for significant adverse effects and drug interactions should not be underestimated. The toxicities of apalutamide are manageable with experience and should be managed proactively to minimize their impact on patients. Monitoring of patients for apalutamide-specific toxicities, including skin rash, hypothyroidism, and QT prolongation should be carried out regularly, particularly in the first few months following initiation. Monitoring should continue alongside monitoring for toxicities of androgen deprivation, including cardiovascular risk, hot flashes, weight gain, bone health, muscle wasting, and diabetic risk. This review is a practical guide to the use of apalutamide describing the management of patients including dosing and administration, toxicities, potential drug interactions, and safety monitoring requirements.

Syphilis and Beyond: A Comprehensive Analysis of Associated Infections and Comorbidities in a Five-Year Retrospective Study in the United Arab Emirates (2018-2022)

Objectives This study explores the clinical characteristics, associated infections, and management outcomes of syphilis within a specific population over the years 2018 to 2022. With a focus on the frequency, clinical manifestations, and co-infections of syphilis, the research addresses a critical gap in understanding the nuanced dynamics of this sexually transmitted infection and its impact on public health. Methods The study employs a retrospective analysis of data collected from 2018 to 2022, utilizing three key serological tests (Syphilis AB, RPR/VDRL, and TPHA) to characterize syphilis infections within the population. Clinical manifestations and associated infections, including HIV, HBV, HCV, Chlamydia, Gonorrhea, and HPV, are systematically assessed. Treatment rates and re-infection patterns are also analyzed, providing a comprehensive overview of syphilis epidemiology within the studied timeframe. Results The frequency of syphilis, particularly indicated by the Syphilis AB test, exhibited a marked increase in 2020, reaching 96%, suggesting a heightened frequency within the population. RPR/VDRL test results demonstrated consistent frequency, emphasizing the persistent presence of active syphilis infections. Clinical manifestations, such as chancre, skin rashes, alopecia syphilitica, and lymphadenopathy, displayed dynamic patterns over the study years. Co-infection rates varied, with fluctuations observed in HIV, Chlamydia, Gonorrhea, and HPV, while HBV and HCV showed infrequent but stable frequency. The management of syphilis cases demonstrated commendable treatment rates, but an increase in re-infection rates in 2021 highlights the need for continued vigilance. Conclusion This study provides a comprehensive evaluation of syphilis epidemiology, clinical characteristics, and associated infections within the studied population. The results offer valuable insights into the dynamic nature of syphilis and its co-infections, informing public health initiatives and interventions. The findings contribute to our understanding of the epidemiological landscape and underscore the importance of sustained efforts in both prevention and treatment to curb the transmission of syphilis and its associated infections. The study, however, calls for continued vigilance and research to address the evolving trends and challenges in syphilis management within the specified population.

Self-limiting Skin Rash Found in a Patient with Suspected Malignant Hyperthermia Attack - A Case Report

Abstract Malignant hyperthermia (MH), a life-threatening complication during general anesthesia, primarily triggers hypermetabolism and skeletal muscle damage. The common MH signs include elevated body temperature, tachycardia, hypercapnia, muscle rigidity, rhabdomyolysis, hyperkalemia, and metabolic acidosis. However, MH-related skin lesions are rarely documented. Here, we present a case of a 3-year-old patient experiencing self-resolving skin rash during an MH episode. A healthy 3-year-old girl underwent strabismus surgery under general anesthesia, displaying the MH episode during the procedure. The significant vital signs included hypercapnia, tachycardia, and hyperthermia, peaking 120 min postinduction. Prompt measures, including sevoflurane discontinuation, hydration, cooling, and alternative anesthesia, swiftly stabilized the patient. Intriguingly, an hour later, an isolated skin rash emerged on the right calf and toes, which gradually resolved without intervention. Postoperative examinations revealed no adverse effects. Despite its rarity, the occurrence of MH-associated skin rashes emphasizes the need for vigilance, especially in pediatric strabismus surgeries, despite minimal documented incidents. In summary, our case highlights the self-limiting nature of MH-related skin rash, occurring post-MH resolution. Its causative mechanisms warrant further investigation. Proactive avoidance of MH trigger agents remains crucial for optimal care during pediatric strabismus surgeries.

Skin Rash During Epstein-Barr Virus-Induced Infectious Mononucleosis in Adolescents and Adults: Incidence, Predisposing Factors, and Prognostic Implications.

Skin Rash During Epstein-Barr Virus-Induced Infectious Mononucleosis in Adolescents and Adults: Incidence, Predisposing Factors, and Prognostic Implications.

Indoor air quality and sick building syndrome symptoms in administrative office at public university

Sick Building Syndrome (SBS) is an illness among workers linked to time spent in a building. This study aimed to investigate the Indoor Air Quality (IAQ) and symptoms of Sick Building Syndrome (SBS) among administrative office workers. The IAQ parameters consist of ventilation performance indicators, and physical and chemical parameters were measured using specified instruments for three days during weekdays. The SBS symptoms were assessed by a questionnaire adopted from the Industry Code of Practice of Indoor Air Quality (ICOP-IAQ) 2010 among 19 employees from the office in East Coast Malaysia. Relationship between past symptoms and present symptoms which are draught (past symptoms) with feeling heavy headed (present symptoms) (r = 0.559, p < 0.05), room temperature too high (past symptoms) was highly correlated with feeling heavy headed (present symptoms) (r = 0.598, p < 0.01) and cough (present symptoms) (r = 0.596, p < 0.01). Room temperature (past symptoms) has a positive medium relationship with cough (present symptoms) (r = 0.477, p < 0.05) and scaling itching scalp or ears (present symptoms) has a relationship between stuffy bad air (r = 0.475, p < 0.05) and dry air (r = 0.536, p < 0.05). There was a significant association between RH with drowsiness (χ2 = 7.090, p = 0.049) and dizziness (χ2 = 7.090, p = 0.049). The association was found between temperature and SBS symptoms between temperature with headache (χ2 = 7.574, p = 0.051), feeling heavy-headed (χ2 = 8.090, p = 0.046), and skin rash itchiness (χ2 = 7.451, p = 0.044). Air movement also showed a positive association with symptoms of feeling heavy-headed (x2 = 8.726, p = 0.021). PM10 has positive significance with SBSS which are feeling heavy-headed (χ2 = 7.980, p = 0.023), and eyer's irritation (χ2 = 7.419, p = 0.038). The conclusion of this study showed that there were positive significant between temperature and relative humidity toward SBSS.

Traditional healers' perception on scabies causation and management in Ghana.

Scabies is an underdiagnosed skin infestation caused by the Sarcoptes scabiei mite. The infection causes severe itching and a skin rash but can be effectively treated using topical or systemic drugs. Scabies outbreaks are commonly reported in resource-poor countries, including Ghana. Traditional healers play an important role in primary care in rural areas. The role of these traditional healers in the management of scabies has so far not been explored. The aim of this study was therefore to investigate the perceptions of traditional healers regarding the causation and management of scabies. A phenomenological qualitative approach was employed. Traditional healers in the Asante Akim North and Central districts in Ghana were approached with an interview request. Using a semi-structured interview protocol, 15 traditional healers were interviewed. The results were coded and analysed, after which seven themes were extrapolated. Scabies infections were frequently reported by traditional healers. Itching and skin rash were unanimously regarded as the major symptoms of scabies. The majority acknowledged the infectious nature of scabies, but no participant reported the causative organism. A dichotomous disease classification was noted, consisting of 'natural' and 'spiritual' variants each with a unique disease profile and management requirements, as reported by the traditional healers. All but two traditional healers reported to treat scabies using almost exclusively herbs and spiritual rituals. The majority of traditional healers were open to collaboration with allopathic healthcare providers. Collaboration could broaden the primary care network in rural areas, but mistrust and lack of transparency form potential barriers to collaboration. We, therefore, emphasise the need for additional efforts to investigate strategies for future collaboration.

Clinical manifestations and seasonal occurrence of patients with dengue hospitalized at Dhaka city of Bangladesh in 2021

For the past few years, the intensity of dengue in Bangladesh has been rising. The current study was done among 533 dengue patients hospitalized in 2021 in Dhaka to observe the different aspects of clinical manifestations and seasonal occurrence of dengue. Due to COVID-19 restriction, hospital entry and face-to-face interview of the patients was not possible. Hence, contact numbers of the hospitalized dengue patients were collected from Directorate General of Health Services (DGHS) and patients were interviewed over the phone. Out of 533 patients, majority were from Dhaka south city corporation (DSCC) (53.7%), had a monthly household income of 30001≥ BDT (67.4%), and lived in small sized families (76.9%). High fever (p=0.013), headache (p&lt;0.001), body pain (p&lt;0.001), vomiting/nausea (p=0.0085), skin rash (p=0.033), eye lesion/red eyes (p=0.0011), pleural effusion (p=0.0404), weakness (p=0.017) and gum bleeding (p=0.014)- were significantly associated with age groups whereas vomiting/nausea (p=0.048), skin rash (p=0.002) and eye lesion/red eyes (p=0.032) were significantly associated with gender. 86.7% suffered from thrombocytopenia (&lt;150000 per microliter blood), while 27% were in serious condition with lowest platelet count ≤ 20000 per microliter blood. 3.6% patients were admitted to ICU and 1.7% died of dengue. Death due to dengue was significantly associated with age groups (p &lt;0.05) and majority among them were children (≤ 10 years). Family members of 44.6% patients were also affected with dengue and majority of the patients belonged to small sized families. Dengue occurrence had significant association with season where majority of the patients were from monsoon season (65.29%) followed by post-monsoon (33.21%) season. Dengue manifests a wide spectrum of symptoms as shown by the study, so now it is necessary to identify the changes in pattern of the clinical manifestations, and effective disease management to lessen the severity of the outbreak. Dhaka Univ. J. Biol. Sci. 33(1): 33-46, 2024 (January)

Mesalazine Induced Pancytopenia in Crohn's Disease

Mesalazine, or 5-aminosalicylic acid, is an anti-inflammatory drug frequently used in patients suffering from chronic inflammatory bowel disease, and is generally well tolerated. Its most common side effects are mainly limited to gastrointestinal disorders, headaches, joint pain and skin rashes, and are generally modest and transient. Serious hematological toxicity is very rare (&lt;1/10000), but cases of thrombocytopenia, aplastic anemia, pancytopenia and leukopenia/agranulocytosis have been reported. We report here the case of a patient with inflammatory phenotype colonic Crohn's disease on mesalazine 3g/day who presented with initial leukopenia aggravated by the development of pancytopenia

Hemophagocytic lymphohistiocytosis and myopericarditis induced by campylobacter: a case report

BackgroundHemophagocytic lymphohistiocytosis (HLH) is a severe disorder characterized by excessive activation of the immune system, leading to hypercytokinemia and damage to multiple organs. We report a rare case of HLH with myopericarditis caused by Campylobacter infection.Case presentationA 28-year-old male patient with a history of hypertension without medicine control presented at the hospital after a four-day fever, decreasing urine amount, rashes on his trunk and limbs, and other symptoms. He was admitted with a provisional diagnosis of atypical infection and allergic skin rash related to diclofenac. However, his condition deteriorated, and he developed shock, tachycardia, chest distress, and bilateral pleural effusion after admission. Further investigations revealed cardiogenic shock related to myopericarditis, and he was transferred to the ICU. In addition, a stool PCR panel subsequently revealed a positive result for Campylobacter. On day 6, he was diagnosed with HLH. Under Clarithromycin and dexamethasone infusion, leukocytosis, anemia and thrombocytopenia with cardiogenic shock status improved. Then, he was later discharged in stable condition.ConclusionsHLH and myopericarditis caused by Campylobacter are very rare. Early detection of Campylobacter-induced HLH and multiple organ failure, as well as prompt use of antibiotics and immunosuppressants, can be helpful for prognosis.

Clear the Skin Formula, et al. Chinese medicine for skin rash, recalled in Australia

Clear the Skin Formula, et al. Chinese medicine for skin rash, recalled in Australia

Analise de hábitos e comportamentos relacionados ao uso de medicamentos em crianças de até 12 anos de idade

People who use medications without guidance represent a significant risk factor for the development of adverse effects in the pediatric population. However, the literature still lacks studies evaluating this phenomenon. In this context, the objective was to identify habits and behaviors related to medication use in children up to twelve years old. For this purpose, the methodology employed was a descriptive cross-sectional study, using a questionnaire on the Google Forms platform for parents and guardians to respond. Subsequently, the data were analyzed using the SPSS software version 19. As a result, it was observed that caregivers often rely on doctors for medication guidance, and some children receive prescribed medications intended for another child, mainly due to similar symptoms or illnesses. The majority of children did not experience adverse reactions to medications, but a small percentage reported allergic reactions, skin rashes, and drowsiness. Furthermore, easy access to medications, lack of healthcare services, inappropriate medication use, and medication storage at home are highlighted. Based on the observed practices, it can be concluded that safe medication practices in pediatric populations are important, as well as the role of healthcare professionals in guiding parents.

Abstract CT037: A phase I investigator-initiated trial of evorpacept (ALX148), lenalidomide and rituximab for patients with relapsed or refractory B-cell non-Hodgkin lymphoma

Abstract Introduction. We have recently demonstrated that pro-tumoral SIRPα+ macrophages may mediate resistance to lenalidomide and rituximab (R2) in patients (pts) with relapsed or refractory (RR) B-cell non-Hodgkin lymphoma (B-NHL). Evorpacept (ALX148) is a novel high-affinity CD47 blocker that abrogates the ‘do-not-eat-me signal’ provided to SIRPα+ macrophages. In a phase I trial including 33 pts with RR B-NHL it was well tolerated in combination with rituximab. We hypothesized that evorpacept and R2 will be synergistic, and the combination will be safe and effective for the treatment of pts with RR B-NHL. Methods. This single arm phase I study (NCT05025800) was conducted between 11/2021 and 9/2023 (data cut-off 12/2023). Adult pts with RR B-NHL who had received at least 2 prior lines of systemic therapy (1 in case of indolent B-NHL [iNHL]) were included. Evorpacept was administered intravenously (IV), in a 28-day cycle, for 12 cycles, at two dose levels (DL): 30 mg/Kg on day (D) 1 and D15 (DL1), or 60 mg/Kg on day 1 (DL2); rituximab IV was given weekly during cycle 1, and on D1 during cycles 2-6; lenalidomide was given orally on D1-21 during cycles 1-6. Dose limiting toxicity (DLT) was evaluated according to CTCAE v5 during cycle 1 and a Bayesian Optimal Interval design was used, with a target DLT rate of 0.3. Response was assessed according to Lugano 2014 criteria. Results. Twenty pts were included in the study. Median age was 61 (27-85), 10 (50%) were male, and 7 (35%) were non-white; 15 (75%) had follicular lymphoma, 3 (15%) marginal zone lymphoma, 1 (5%) mantle cell lymphoma, and 1 (5%) Richter Syndrome; 20 (100%) had previously received an anti-CD20 monoclonal antibody, 13 (72%) chemoimmunotherapy, and 15/18 (83%) iNHL pts had intermediate-high FLIPI. Three pts were treated at DL1, 17 at DL2, and no DLT was observed. The most common grade 3-4 adverse events included: neutropenia (55%), infections (30%), ALT increase (15%), AST increase (10%), skin rash (10%), and anemia (10%). Eight (40%) pts experienced a cycle delay, mainly due to grade (G) 1 AST/ALT elevation; 6 (30%) required a dose reduction for lenalidomide, none for evorpacept; 1 pt discontinued treatment after 1 cycle due to G3 lenalidomide-associated myocarditis. Sixteen (80%) pts achieved CR and best overall response rate was 90%. After a median follow-up of 16 months (95% CI, 12-20 months), 1-year PFS rate was 70% and 1-year OS rate was 90%. Conclusions. The combination of evorpacept and R2 is well tolerated in pts with RR B-NHL, with similar toxicity and promising anti-tumoral activity as compared to historical CR rates with R2 alone (34%). Bulk RNA sequencing and multiplex immunofluorescence are being performed on tissue biopsies collected before and during treatment, to characterize its effects on the tumor immune microenvironment. A phase 2 study investigating its efficacy in pts with previously untreated iNHL is now enrolling. Citation Format: Paolo Strati, Lei Feng, Dai Chihara, Jason Westin, Sairah Ahmed, Luis Fayad, Jared Henderson, Jeffrey Davidson, Elizabeth McChesney, Loretta Nastoupil, Sattva Neelapu, Christopher Flowers. A phase I investigator-initiated trial of evorpacept (ALX148), lenalidomide and rituximab for patients with relapsed or refractory B-cell non-Hodgkin lymphoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr CT037.