Rash Research Articles

Health Effects of Pesticides among Small Scale Farmers in an Urban Municipality of Nepal: A Descriptive Study

Introduction: Pesticides cause short-term as well as long-term health effects. Agriculture workers are at high risk of effect. So, this study aimed to identify the health effects of pesticides among small-scale farmers in the municipality of Bhaktapur, Nepal. Methods: This was a community-based cross-sectional descriptive study conducted in all wards of Changunarayan Municipality, Bhaktapur, Nepal. Farmers of selected households who adopted agriculture as their main occupation were included in this study. The sample size for the study was 132. Proportionate stratified sampling was used to determine the farmer from each ward and simple random sampling was used to reach every respondent. Face-to-face interview technique and semi-structured questionnaire was used for data collection. The data were analyzed using descriptive statistics and the Chi-square test was applied to measure an association between selected variables. Results: All of the farmers used pesticides and about two-thirds 74(64.9%) experienced both immediate as well as delayed symptoms due to the use of pesticides. Majority of them showed general symptoms such as eye irritation 87(76.3%), difficulty in breathing 70(61.4%) and fatigue 55(48.2%). There was an association between the frequency of exposure and health effects due to pesticide use which was found to be statistically significant at a significance level with p-value 0.042. Conclusion: Health effects such as skin rashes, effects on the eyes, and respiratory system were reported. The most prevalent effects were eye irritation, difficulty in breathing, and itching of the skin. Training on pesticide use and awareness should be conducted by municipalities to reduce the effects.

Adverse drug reactions, adherence, and virologic outcomes in adult patients on dolutegravir- based antiretroviral therapy at a tertiary hospital, southeast Nigeria

Objective: To assess the adherence, adverse drug reactions (ADR), and virologic outcomes of dolutegravir-based antiretroviral therapy.Design: This was a retrospective chart review.Setting: A tertiary health facility-based study in Abakaliki, Nigeria.Participants: Five hundred and fifteen (515) adult patients on dolutegravir were selected using a Random Number Generator. Demographic and clinical data were extracted from patients’ case notes and analysed with IBM-SPSS version-25.Main outcome measures: Adherence to dolutegravir, ADRs, virologic outcome, and change in Body Mass Index (BMI) were estimated.Results: The mean age of the patients was 45.5±10.8 years; 68.2% of them were females; 97.1% of them had good self-reported adherence. The majority (82.9%) of them reported no ADRs and among those (17.1%) that did, headache (9.7%), body-itching (3.1%), and skin rash (2.7%) dominated. Most achieved viral suppression (94.4%) and did not have detectable viral particles (57.4%). There was a significant increase in the BMI of the patients with a mean weight increase of 0.9kg, a mean BMI increase of 0.3 kg/m2, and a 2.6% increase in the prevalence of overweight and obesity.Conclusions: Patients on dolutegravir reported low ADRs, good self-reported adherence, and a high viral suppression rate. However, dolutegravir is associated with weight gain. We recommend widespread use and more population-wide studies to elucidate the dolutegravir-associated weight gain.

Sirolimus experience in adult patients with vascular malformations.

Sirolimus, a mammalian target of rapamycin inhibitor, inhibits cell growth and proliferation by controlling ribosome biogenesis and protein synthesis in vascular anomalies and cancers. However, most sirolimus studies on vascular anomalies were conducted in the pediatric population, with limited data in adults. In this study, we assessed the effectiveness and safety of sirolimus in adult patients with vascular malformation, a subtype of vascular anomaly. We conducted a retrospective analysis of adult vascular malformation patients aged over 16, treated at Hacettepe University Cancer Institute from January 2013 to September 2022. Patient demographics and clinical characteristics were recorded. The primary outcome was the efficacy of sirolimus evaluated by response and disease control rates. The disease control rate was defined as the cumulative percentage of complete or partial responses, along with stable disease. The secondary endpoint was toxicity and safety. 38 patients with a median age of 21 (IQR: 18-33) were recruited. Prior to sirolimus treatment, 57.9% of patients had undergone other therapeutic interventions, predominantly sclerotherapy and surgery. The median follow-up time during sirolimus treatment was 18.5 (IQR: 11.3-74.5) months. The disease control rate was 92.1% (35/38). Head-neck localization was associated with better response rates (p = .001). Sirolimus was generally well tolerated and grade 1 or 2 oral mucositis (n = 4) and skin rash (n = 3) were the most common side effects. In this study, we found sirolimus was efficacious and well tolerated in adult patients with vascular malformation.

Abstract 3128: HRA00184-C004, preclinical characterization of a novel tissue factor-targeted antibody-drug conjugate

Abstract The physiological function of tissue factor (TF) is to initiate coagulation cascade by forming complex with plasma Factor VII after vascular injury. For Tisotumab vedotin (Tivdak), a TF targeting antibody-drug conjugate (ADC) approved for the treatment of cervical cancer, bleeding events were prespecified as adverse effects (AEs) of interest, besides ocular toxicity and peripheral neuropathy (known MMAE payload related AE). In order to mitigate the bleeding risk, a next generation of TF-targeting ADC is developed by Hengrui Pharmaceuticals. HRA00184-C004 is a novel ADC comprising a differentiated TF-targeted antibody (HRP07132) conjugated to a proprietary topoisomerase I inhibitor (Dxh, an exatecan derivative) via a protease-cleavable linker. In contrast to most TF-targeting antibodies, the naked HRP07132 does not interfere the interaction between TF and Factor VII or Factor X, has no impact on coagulation function in prothrombin time and thrombin generation assay, therefore reduced bleeding incidence is expected for HRA00184-C004. Meanwhile, HRA00184-C004 exhibited not only potent growth inhibition against multiple TF-expressing cancer cell lines but also bystander-killing effect in vitro. HRA00184-C004 also displayed robust and sustained anti-tumor activities in the PDAC HPAFII (TF high), TNBC MDA-MB-231 (TF moderate) and NSCLC H358 (TF low) TF-expressing xenograft models. Furthermore, in cynomolgus monkey, HRA00184-C004 is well-tolerated over a 6-week period with 12 mg/kg dosing every 3 weeks with acceptable PK profile. Notably, neither coagulation disorder nor skin rash was observed, which are superior to the historical NHP data reported by Tivdak. In conclusion, with the encouraging efficacy in preclinical study and promising safety profiles in NHPs, HRA00184-C004 has demonstrated the best-in-class potential and is scheduled to advance into clinical development. Citation Format: Hanxiao Ying, Lingfeng You, Ning He, Shaoyu Xu, Pu Pu, Sophie Lin, Jun Feng, Zhe Zhang, Xin Ye, Min Hu, Feng He. HRA00184-C004, preclinical characterization of a novel tissue factor-targeted antibody-drug conjugate [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3128.

Abstract 1956: Discovery of a novel and potent mutant-selective inhibitor of PI3Kα

Abstract Gain-of-function mutations in hotspots of PI3Kα including H1047R, E545K, and E542K are well-recognized oncogenic drivers in human cancers. Prevalence of these mutations is enriched in many human malignancies, particularly in hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2−) breast cancer. PI3Kα inhibition showed clear clinical benefit in treating HR+/HER2− breast cancer and has been approved in combination with fulvestrant. First generation PI3Kα inhibitors such as alpelisib and inavolisib, however, have limited selectivity against wild-type (WT) PI3Kα; therefore, are associated with a variety of on-target adverse effects including grade 3 hyperglycemia, skin rash, and gastrointestinal toxicities. Discovery of a highly-selective inhibitor of mutant PI3Kα could enable deeper target coverage while reducing undesired effects of inhibiting WT PI3Kα. SNV-002 is a novel, proprietary, and mutant-selective inhibitor of PI3Kα. In cellular assays, SNV-002 inhibited Ser473 phosphorylation of AKT (pAKT) with single digit nanomolar potency in PI3Kα H1047R-mutant T47D cells and displayed greater than 50-fold selectivity over SKBR3 WT control. Similar inhibition of pAKT was also observed in other cell lines carrying PI3Kα hotspot mutations, such as CAL33, NCI-H1048, EFM19, and HCC1954. SNV-002 maintained selectivity in helical domain E545K-mutant cell lines including MCF7 and MDA-MB-361. This selectivity was further confirmed using MCF10A isogenic cell lines carrying either WT or mutant PI3Kα (H1047R and E545K). In cellular assays to assess inhibition of other isoforms of PI3K (PI3Kβ, PI3Kγ, and PI3Kδ), the IC50 of SNV-002 was over 10,000 nM. Similarly, a broad kinome screen showed no inhibition of activity of 371 kinases. Compared with alpelisib, SNV-002 showed improved potency and prolonged residence time in T47D breast cancer cells. Importantly, assays using H1047R-mutant cells in the presence of human whole blood showed SNV-002 potency to be less than 100 nM, which was over 10-fold more potent than that of alpelisib. Treatment of breast cancer cells with SNV-002 suppressed PI3K-AKT-mTOR pathway, as evidenced by reduced levels of phospho-S6 ribosomal protein and associated with loss of cell viability in mutant lines. The pharmacokinetic profile of SNV-002 was excellent across multiple species. Oral administration of HCC1954 tumor-bearing mice with SNV-002 resulted in dose-proportional exposure and >90% pharmacodynamic inhibition of pAKT in the tumor with doses of 10 mg/kg, and no sign of glucose dysregulation in contrast to alpelisib. Together, these data show that SNV-002 is a highly-selective and potent inhibitor of mutant PI3Kα with good drug-like properties that support further development of SNV-002 for treatment of cancers driven by oncogenic PI3Kα mutations. Citation Format: Mingming Gao, Chao Qi, Zhentian Li, Qipeng Fan, Liyang Wang, Fei Zhou, Lin You, Hewen Zheng, Yu Li, Liangxing Wu, Wenqing Yao, Phillip C. Liu. Discovery of a novel and potent mutant-selective inhibitor of PI3Kα [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1956.

Abstract 4052: Neutrophil recruitment and activation promotes cutaneous adverse effects with T cell immunotherapies

Abstract Immune-based therapies that induce tumor regression are often accompanied by immune-related adverse events (irAEs) which can occasionally present with severe and lethal symptoms. Currently, there are no well-defined preventative approaches to uncouple anti-tumor immunity from irAEs. Currently approved immunotherapies include agents that activate T cell responses, such as antibodies blocking immune checkpoints and infusion of tumor-derived, T cell receptor-transgenic or chimeric antigen receptor-modified T cells. While the beneficial and toxic effects of T cell-based therapies in the clinic are being extensively explored, the precise mechanisms underlying their activity remain the subject of investigation. In this study, we treated preclinical models of established melanomas with tumor-specific adoptive CD4+ T cell transfer in combination with T cell co-stimulation via OX40 agonism or CTLA-4 blockade. We found that, despite adequate T cell stimulation, acute local inflammation plays an important role in tumor elimination and the manifestation of irAEs. While stimulated T cells are necessary for initiating a therapeutic response, activation of endogenous neutrophils constitutes an important and necessary effector mechanism for both tumor destruction and the development of irAEs. Extensive neutrophil extracellular traps (NETs) were associated with irAEs. Furthermore, melanoma patients treated with immune checkpoint blockade with skin rashes equivalent to irAEs found in mice showed increased survival and NETs in biopsies from both rashes and tumors. Our results bring forward a novel paradigm where T cells prime an anti-tumor immune response that is followed by an inflammatory effector mechanism provided by the innate immune system, resulting in both curative and undesirable side effects in mice and patients. Citation Format: Daniel Hirschhorn, Lukas Kraehenbuehl, Sadna Budhu, Valeria Estrada Navarro, Levi Mark B Mangarin, Yacine Marouf, Jacob Ricca, Billel Gasmi, Olivier De Henau, Yanyun Li, Czrina Cortez, Hamadene Linda, Isabell Schulze, Cailian Liu, Katherine Panageas, Mario Lacuoture, Gabrielle A. Rizzuto, Mikala Egeblad, Jedd D. Wolchok, Taha Merghoub Merghoub. Neutrophil recruitment and activation promotes cutaneous adverse effects with T cell immunotherapies [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4052.

Real-world analysis of apalutamide-associated skin rash in Chinese patients with prostate cancer.

This study aimed to explore the clinical characteristics of apalutamide-associated skin rash and management of skin rash in real-world Chinese patients with prostate cancer. We investigated 138 patients with prostate cancer who received apalutamide in the Second Hospital of Tianjin Medical University from January 2022 to March 2023. The primary end points were the incidence of skin rash and the time to skin rash. The second end points were the grade of skin rash, the time to remission, the rate of recurrence of skin rash, clinical risk factors and management of skin rash. One hundred patients were analyzed. Patients were a median of 73years old (IQR 68-77.75). Thirty-two patients (32%) developed apalutamide‑associated skin rash. The median time to incidence and remission of skin rash were 57.5 and 11.5days, respectively. Of 32 skin rash, 27 patients had apalutamide therapy maintained after rash remission. There were seven patients having recurrence of skin rash. By multivariable logistic regression analysis, we revealed that hypertension history (OR 3.22, 95% CI 1.09-9.53, p = 0.035), bad life-styles (OR 3.29, 95% CI 1.11-9.8, p = 0.032), ECOG ≥ 1 (OR 3.92, 95% CI 1.33-11.55, p = 0.013), and high tumor burden (OR 3.13, 95% CI 1.07-9.14, p = 0.037) were independently associated with higher incidence of skin rash. Nearly one-third of Chinese patients experienced skin rash after taking apalutamide in our study. The poor health patients might have a higher incidence of apalutamide-associated skin rash.

Viruela símica: reporte de un caso clínico

Monkeypox is a zoonosis-type disease caused by a virus of the genus Orthopoxvirus. Usually accompanied by systemic symptoms such as fever, headache, myalgia, asthenia, skin rashes or mucosal lesions. This disease is transmitted by physical contact with infected people, infected materials or animals. We present the case of a 6-year-old patient who came to primary care for symptoms compatible with clinical suspicion. Monkeypox was diagnosed under positive PCR and discharged with outpatient symptomatic management.

The Effect of Extensive Hydrolyzate Formula on the Growth and Development of Infants With Cow's Milk Allergy

Cow's milk allergy is a common condition in babies and children. Allergic reactions can occur when the body reacts to the proteins in cow's milk, causing various symptoms such as skin rashes, vomiting, diarrhea, or even more serious reactions. Babies who suffer from cow's milk allergy need appropriate treatment so that their growth and development is not disrupted. One approach used in managing cow's milk allergy is to provide an extensive hydrolyzate formula. The aim of this study was to evaluate the effect of providing extensive hydrolyzed formula on the growth and development of babies suffering from cow's milk allergy. This study used qualitative research methods. The data collection technique in this research is literature study. The data that has been collected is then analyzed in three stages, namely data reduction, data presentation and drawing conclusions. The results of the study concluded that the use of extensive hydrolyzed formula is an effective choice for babies who are allergic to cow's milk. This research shows that this formula has a positive impact on the baby's weight growth according to his age. However, in terms of infant development, there is no significant difference in the effect between the use of extensive hydrolyzed formula and soy protein isolate on various aspects, including global development, gross motor skills, fine motor skills, language and social personality in children who are allergic to cow's milk

Clinical, radiological and molecular responses to combination chemotherapy with MAPK pathway inhibition in relapsed and refractory Langerhans cell histiocytosis.

Optimal therapeutic approaches for advanced Langerhans cell histiocytosis (LCH) are not known. We assessed the safety and efficacy of combined chemotherapy with MAPK pathway inhibition in 10 patients with refractory systemic disease and/or LCH-associated neurodegeneration. Overall response rate was 9/10 (90%) for the entire cohort: 5/5 (100%) for patients with systemic disease and 6/7 (86%) for patients with central nervous system disease. BRAFV600E+ peripheral blood fraction decreased in 5/6 (83%). Toxicities included fever, skin rash, myalgias, neuropathy, cytopenias and hypocalcaemia. Prospective trials are required to optimize combination strategies, determine potential to achieve cure and compare outcomes to chemotherapy or MAPK inhibitor monotherapy.

Large-scale spatial drivers of avian schistosomes in Northern Michigan inland lakes.

Avian schistosomes are snail-borne trematode parasites (Trichobilharzia spp.) that can cause a nasty skin rash in humans when their cercariae mistake us for their normal bird hosts. We sought to investigate drivers of the spatial distribution of Trichobilharzia cercaria abundance throughout Northern Michigan lakes. For 38 sites on 16 lakes, we assessed several dozen potential environmental predictors that we hypothesized might have direct or indirect effects on overall cercaria abundance, based on known relationships between abiotic and biotic factors in wetland ecosystems. We included variables quantifying local densities of intermediate hosts, temperature, periphyton growth rates, human land use and hydrology. We also measured daily abundance of schistosome cercariae in the water over a 5-week period, supported by community scientists who collected and preserved filtered water samples for qPCR. The strongest predictor of cercaria abundance was Lymnaea host snail density. Lymnaea density was higher in deeper lakes and at sites with more deciduous tree cover, consistent with their association with cool temperature habitats. Contrary to past studies of human schistosomes, we also found a significant negative relationship between cercaria abundance and submerged aquatic vegetation, possibly due to vegetation blocking cercaria movement from offshore snail beds. If future work shows that these effects are indeed causal, then these results suggest possible new approaches to managing swimmer's itch risk in northern MI lakes, such as modifying tree cover and shallow-water vegetation at local sites.

Persistent fever in acute hepatitis: think beyond acute viral hepatitis

Background Acute hepatitis due to various tropical infections can mimic the clinical picture of acute viral hepatitis(AVH), leading to increased morbidity and mortality. We aimed to identify clinical and laboratory parameters that could help to distinguish acute hepatitis due to tropical infections from AVH. Methods We retrospectively analyzed our database of 150 children (107 boys) with AVH and 50 children(34 boys)with acute hepatitis due to tropical infections between January 2013 and March 2023. Clinical features, investigations, complications and outcomes were compared. Results Hepatitis A (75%) was the commonest etiology of AVH while enteric fever (34%), dengue (26%), scrub typhus (20%) and leptospirosis (16%) constituted the majority of tropical infections. Persistent fever and skin rashes were found in 88% and 16% of patients respectively in the tropical infection group and none in the AVH group (p < 0.001). On univariate analysis, prodromal symptoms, clinically detectable jaundice, cholestatic pattern, total and direct bilirubin and liver enzymes were significantly higher in AVH while headache, myalgia, leukopoenia, thrombocytopenia, hyponatremia were significantly higher in tropical infections group (all p < 0.05). Multivariate analysis identified thrombocytopenia (Odds ratio [OR] 4.237) as an independent positive predictive factor and markedly elevated total bilirubin (OR 0.575), direct bilirubin (OR 0.498), aspartate aminotransferase (OR 0.841) and alanine aminotransferase (OR 0.863) as independent negative predictive factors for acute hepatitis due to tropical infections. Conclusion High index of suspicion for tropical infections is warranted in patients with persistent fever after the onset of jaundice, especially in the presence of skin rash and thrombocytopenia. SUMMARY Acute viral hepatitis and acute hepatitis due to tropical infections can have similar clinical and biochemical parameters. Milder degree of jaundice, lower elevation of serum transaminases and thrombocytopenia can be useful predictors for acute hepatitis due to tropical infections.

Adherence to medical treatment for Wilson’s disease in children and adolescents: a cohort study from Turkey

BackgroundThis study aimed to assess medication adherence and demographic, clinical, and psychopathological parameters such as quality of life, depression, and anxiety levels that can affect pediatrics with Wilson’s Disease (WD).MethodsA prospective cohort study was conducted at an outpatient clinic in Turkey among pediatric patients (2 to 18 years) with WD between November 2022 and April 2023. The Medication Adherence Report Scale (MARS-5) as a subjective and Medication Possession Ratio (MPR) as an objective assessment were scored. Physical, genetic and biochemical parameters, the Pediatric Quality of Life Inventory (PedsQL) for both parents and patients, Childhood Depression Inventory, State Trait Anxiety Inventory were also administered.ResultsA total of 30 pediatric outpatients who were prescribed D-penicillamine (n = 27) or trientine (n = 3) as chelators and zinc (n = 29) and pyridoxine (n = 19) as supplements were included. Proteinuria (n = 3), skin rash (n = 2), and gastrointestinal upset (n = 2) were observed. When the correlation between MARS-5 and duration of follow-up was examined, a significant negative correlation was found (p = 0.014). According to MPRs, non-adherence rates (missed doses ≥ 20%) were 29.6%, 17.2% and 5.3% for D-penicillamine, zinc and pyridoxine, respectively. PedsQL scores were higher than those of parents, with a positive correlation between them (p < 0.001). Also, there was a significant positive correlation between PedsQL and State Anxiety Inventory (p < 0.001). Comparing the change in urinary copper levels between different levels of treatment knowledge, significant differences were observed between high- and low levels (p = 0.043).ConclusionsOverall, nonadherence rates were 23.3% based on MARS-5 and 5.3–29.6% based on MPR. It is essential to consider factors such as the duration of follow-up, biochemical parameters, treatment knowledge, quality of life and anxiety as potential influencers of medication adherence.

CLINICAL FEATURES AND SHORT-TERM OUTCOME OF COVID-19 IN PEDIATRIC PATIENTS IN A TERTIARY CARE HOSPITAL OF CENTRAL INDIA: A CROSS-SECTIONAL STUDY

Objectives: To fill the knowledge gap and make a clinical profile (frequency, clinical features and outcome) of COVID-19 paediatric patients attending the tertiary care hospital of central India. Methodology: This cross-sectional study was carried out in Department of Paediatrics, R.D Gardi Medical College, Ujjain, M.P among 88 age group of 0-18 years admitted consented COVID-19 positive pediatric patients over a period of one year (March 2021 to April 2022). Results: Fever was the most common (76%) complaint, followed by fatigue/ malaise (52%), dry cough and runny nose (45%). Fever stayed for the longest duration (2.80±2.30 days), followed by loss of smell (1.97±2.43 days). Skin rashes stayed for the least duration (0.09±0.39 days). Stunting was observed in 28% participants. Hospital acquired pneumonia was seen in many (26%), along with liver dysfunction in 19%, ARDS in 18%, meningitis/ encephalitis in 16%, MIS-C in 8% and septic shock in 7%. Most of the study participants (49%) had received Azithromycin; while Ivermectin was given to very few participants (16%). Mean duration of stay in hospital was observed to be 9.01±7.95 days. COVID-19 severely hampered the vulnerable section of the society, i.e., the children. Conclusion: The prevalence was found to be more in females, and increased with advancing age. Overcrowding and under nutrition favoured its spread. Children presented with variable complications, as well.

Complex therapy of contact dermatitis: from theory to practice

This article discusses the relevance of the causes and further development of contact dermatitis. In accordance with the clinical recommendations of the Ministry of Health of the Russian Federation, simple irritable contact dermatitis is an acute or chronic inflammatory skin disease caused by the irritating effect of environmental factors on the skin. Allergic contact dermatitis is an acute or chronic inflammatory skin disease that occurs in response to skin contact with substances that can cause sensitization and specific allergic inflammation. Allergic contact dermatitis can develop because of a reaction to absolutely any substance. This is a common pathology among skin diseases, manifested by polymorphic symptoms and its regression as the etiological factor and appropriate therapy disappear. The mechanisms of development of various forms of dermatitis are described, the immunological disorders that occur in this pathology are indicated, the clinical features are indicated. The publication examines various clinical cases of somatically healthy patients suffering from simple contact and allergic dermatitis caused by variant factors, with localization of the pathological process in the facial area. According to the doctor’s prescription, patients used traditional therapy regimens consisting of external/topical treatment and general therapy, strictly in accordance with clinical recommendations. Topical glucocorticosteroids are the first line of therapy for contact dermatitis and it is extremely important to choose modern drugs with a high safety profile when localizing foci on the face. At the end of the course of treatment, patients noted a significant improvement in the condition of the dermis in the form of minimizing the manifestations of erythema of the skin, the disappearance of polymorphic skin rash elements, and the disappearance of exfoliation.

A typical case of Dermatomyositis

Dermatomyositis, a connective tissue disorder, is an idiopathic inflammatory myopathy characterized by skin manifestation. The diagnosis of dermatomyositis is based on characteristic skin rash, progressive muscle weakness, elevated serum muscle enzymes, abnormal EMG and muscle biopsy findings. Here we present an atypical case of a 68year old lady with all typical clinical findings failed to show response despite proper stepwise management.

Non-ionic contrast material in pediatric ct scans: A statistical analysis of mild allergic reactions.

Objective: To assess allergic reactions to IV non-ionic contrast media in children. Study Design: Cross-sectional study. Setting: Faisal Hospital, Faisalabad, and Children Hospital, Faisalabad. Period: June 2022 to September 2022. Material &amp; Methods: A total of 310 patients (males and females) under the age of 14, referred for a CT scan with non-ionic contrast material were included in the study, Data were collected at the Children’s Hospital and the Faisal Hospital Faisalabad for over 4 months and statistically analyzed by SPSS V22. The Chi-square test was used to measure the association between the age of children and mild allergy reactions. Results: This study included 310 patients, 183 (59%) males, and 127 (41%) females, who received the non-ionic contrast agent. Thirteen patients (6 males and 7 females) experienced mild allergic responses including 5 cases of rash, 3 cases of itching, 2 cases of nausea, and 1 case of vomiting, flushing, and swelling. There were 10 reactions for children under five, 1 for children between five to ten years, and 2 for children older than ten years. Out of 13 reported allergic reactions, the brain region observed seven while the chest, head, and neck regions observed none. Conclusion: According to the findings of this study, imaging young children with low-osmolality non-ionic contrast material is relatively safe and has few side effects. Out of 310, only 13 children experienced mild allergic responses to non-ionic contrast material. This study found an association between the age of children (&lt;5 years) and mild allergic reactions (skin rash and itching) which was found to be statistically significant (p=0.005).

Features of clinical manifestations of secondary syphilis in a HIV infected patient

Syphilis and human immunodeficiency virus (HIV) infection are diseases of an infectious nature with a predominantly sexual route of infection. Despite the decrease in the incidence of syphilis in recent years in Russia, there is an increase in HIV infection.&#x0D; The combination of several infections in one patient leads to changes in clinical manifestations, which sometimes significantly complicates their diagnosis, leading to a late start of treatment. Syphilis against the background of HIV infection proceeds in stages, but usually it has a malignant, aggressive and severe course, often with the development of atypical forms and complications.&#x0D; The primary syphilis against the background of HIV infection is characterized by the appearance of ulcerative-necrotic character of the hard chancre, such severe complications as phagedenism and gangrenization, the frequent addition of a secondary infection, severe soreness of the hard chancre. Secondary syphilides in HIV-infected patients are characterized by the appearance of ulceration with the formation of necrotizing vasculitis, extraordinary infectiousness of the elements. The disease progresses rapidly and over a few months from the moment of infection, manifest neurosyphilis or tertiary syphilis may develop due to immunodeficiency.&#x0D; The authors describe the features of the manifestations of syphilis in its different periods against the background of HIV infection. A clinical case of a 35-year-old woman who was diagnosed with secondary syphilis and HIV infection is presented. The patient had numerous skin rashes, which were interpreted differently by doctors of different specialties for 2 months. The patient was diagnosed with pyoderma, "allergy", infectious exanthema, however, against the background of the treatment, there was a negative dynamics of the skin process. The authors have demonstrated the effectiveness of specific therapy: complete resolution of skin rashes.

Deverji's disease after COVID-19: Case report

Deverji's disease is a rare idiopathic skin disease characterized by keratinization disorder and manifested in follicular hyperkeratosis, orange-red peeling plaques, palmar-plantar keratodermia with the possible development of erythroderma. The etiopathogenesis of this dermatosis is still unknown. There are such possible trigger factors as traumatization, ultraviolet radiation, taking certain medications, autoimmune and oncological diseases, bacterial or viral infection, vaccination. The presence of familial cases is due to a mutation in the CARD14 gene. Diagnosis of the disease is based on characteristic clinical symptoms. The histological picture has no pathognomonic features; however, a biopsy is necessary for differential diagnosis with other papulosquamous dermatoses. Treatment of Deverji's disease remains a difficult task, since the disease pathogenesis has not been fully studied.&#x0D; The article describes a clinical case of Deverji's disease manifestation in a 64-year-old woman who had suffered COVID-19 infection twice. She was admitted to the Department of Dermatology and Venerology (Sechenov University) with complaints of skin rashes on her face, trunk, upper and lower extremities, accompanied by severe itching. The absence of any distinctive clinical and histological changes, the torpidity of the skin process and resistance to the therapy made it difficult to make a diagnosis. After the emergence of characteristic clinical symptoms (palmar-plantar keratodermia, salmon-tinged rashes with islands of healthy skin), as well as the results of repeated histological examination (alternating areas of ortho- and parakeratosis; uneven granular layer; vacuolization of basal cells; uneven broad acantholytic strands; loosened dermo-epidermal junction; small perivascular lymph-macrophage infiltrates) Deverji's disease was diagnosed.&#x0D; The use of standard therapies (systemic glucocorticosteroid therapy, methotrexate, topical therapy) did not give any results, and therefore it was decided to initiate the netakimab. After 5 injections, the first positive results were obtained in the form of the color paling and a decrease in the number of rashes, palmar-plantar keratodermia regression and improvement of the patient psychoemotional state. After 11 injections, almost complete remission was achieved, and treatment was continued until all symptoms disappeared completely.&#x0D; The article provides a literature review of the etiopathogenesis, clinical manifestations and treatment methods of Deverji's disease. The described clinical case is the fifth example in the world of the Deverji's disease manifestation after a COVID-19 infection, and is also the first case of the IL-17 inhibitor netakimab successful use for the disease treatment.

Interleukin-2-induced skin inflammation.

Recombinant human IL-2 has been used to treat inflammatory diseases and cancer; however, side effects like skin rashes limit the use of this therapeutic. To identify key molecules and cells inducing this side effect, we characterized IL-2-induced cutaneous immune reactions and investigated the relevance of CD25 (IL-2 receptor α) in the process. We injected IL-2 intradermally into WT mice and observed increases in immune cell subsets in the skin with preferential increases in frequencies of IL-4- and IL-13-producing group 2 innate lymphoid cells and IL-17-producing dermal γδ Tcells. This overall led to a shift toward type 2/type 17 immune responses. In addition, using a novel topical genetic deletion approach, we reduced CD25 on skin, specifically on all cutaneous cells, and found that IL-2-dependent effects were reduced, hinting that CD25 - at least partly - induces this skin inflammation. Reduction of CD25 specifically on skin Tregs further augmented IL-2-induced immune cell infiltration, hinting that CD25 on skin Tregs is crucial to restrain IL-2-induced inflammation. Overall, our data support that innate lymphoid immune cells are key cells inducing side effects during IL-2 therapy and underline the significance of CD25 in this process.