Standardized Digital Photographs Research Articles

Dose-Dependent Effects of Botulinum Toxin Type A on Prevention of Postoperative Scars in Various Regions in the Body: A Prospective, Double-Blind Randomized Controlled Trial.

Botulinum toxin type A (BTXA) can improve wound healing and reduce scar formation; however, the exact dose required to prevent postoperative scarring across various anatomical sites remains unclear. This study aimed to investigate the effectiveness and optimal concentrations of BTXA for preventing postoperative scarring across various common surgical sites throughout the body. In this prospective randomized controlled trial, 46 patients with benign skin tumors received injections of 1, 2.5, or 5U/0.1mL of BTXA or 0.9% saline immediately following surgical tumor excision on both sides of the incisions. Follow-ups were conducted at 7days, 15days, and 1, 3, and 6months postoperatively. Patient-reported adverse events and standardized digital photographs were collected. Scar formation was assessed using the modified Stony Brook Scar Evaluation Scale (mSBSES). All 46 patients completed the trial without severe complications. The mSBSES scores were higher in the experimental groups at all follow-ups. The 5U/0.1mL BTXA dose group demonstrated optimal scar prevention at all high-risk sites for scar hyperplasia. No significant difference was observed between the 2.5U/0.1mL and 5U/0.1mL doses for intermediate-risk sites, while 1U/0.1mL dose was sufficient for low-risk sites. Overall, 86.5% of patients were satisfied with their treatments, with 16.3% being very satisfied. Early postoperative BTXA injection can reduce or prevent hypertrophic scarring, with optimal doses ranging from 1 to 5U/0.1mL depending on the surgical site, supporting broader clinical application of BTXA. The effectiveness of different concentrations of botulinum toxin type A (BTXA) in preventing postoperative scarring was compared, expanding the scope of previous research, which focused only on the head, face, and neck regions, to include the trunk and extremity areas. Different optimal injection strategies were determined based on different surgical sites and their risks of developing hypertrophic scars. The study demonstrates that BTXA not only reduces scar formation but also enhances patient satisfaction and reduces postoperative itching and pain, contributing to overall better postoperative outcomes. By establishing the efficacy and optimal dosing of BTXA for various surgical sites, this research supports the potential for broader clinical application of BTXA in aesthetic and reconstructive surgeries. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Prefabricated Fibula Flap vs Bone-Driven and Delayed Implant Installation for Jaw Reconstruction

Restoration of dental occlusion and oral rehabilitation is the ultimate goal of functional jaw reconstruction. To evaluate the prefabricated fibula flap (PFF) technique in occlusion-driven jaw reconstruction for benign or previously treated malignant disease. This cohort study was conducted from January 2000 to December 2019 at the University of Alberta Hospital and Institute of Reconstructive Sciences in Medicine in Edmonton, Alberta, Canada, among patients who underwent PFF or bone-driven and delayed osseointegrated implant installation (BDD). Patients were followed up for a minimum of 1 year after occlusal rehabilitation. Data were analyzed from July 2021 to June 2022. Patients underwent BDD or PFF, which consists of osseointegrated dental implant installation and skin grafting of the fibular bone 3 to 6 months before jaw tumor resection or defect reconstruction. The implant osseointegration is completed at the time of jaw reconstruction, allowing for full reconstruction, loading, and restoration of the dental occlusion in the immediate postoperative period. Safety, effectiveness, accuracy, timeliness of occlusal reconstruction, and aesthetic appeal were compared between PFF and BDD. Groups were compared for the following variables: postoperative complications, number of bony segments used, number of procedures needed, total operative time, time to occlusal rehabilitation, and number of implants installed, exposed, lost, and used (ie, exposed implants - lost implants). Aesthetic appeal was assessed using standardized full-face and profile digital photographs taken before and 6 to 12 months after the operation and analyzed by 3 naive raters. Among 9 patients receiving PFF (mean [SD] age, 43.3 [13.0] years; 7 men [77.8%]) and 12 patients receiving BDD (mean [SD] age, 41.9 [18.0] years; 8 men [66.7%]), the overall complication rate was similar (4 patients [44.4%] vs 3 patients [25.0%], respectively; relative risk, 1.78 [95% CI, 0.52 to 6.04]). The number of patients with implant loss was similar between PFF and BDD groups (0 patients vs 3 patients [25.0%], respectively; difference, -25.0 percentage points [95% CI, -48.4 to 9.7 percentage points]). PFF had a clinically meaningful faster mean (SD) occlusal rehabilitation compared with BDD (12.1 [1.9] months vs 60.4 [23.1] months; difference, -48.3 months [95% CI, -64.5 to -32.0 months]). The mean (SD) difference in preoperative to postoperative aesthetic score was similar between PFF and BDD groups (-0.8 [1.5] vs -0.2 [0.8]; difference, -0.6 [95% CI, -1.6 to 0.4]). This study found that PFF compared with BDD was a safe, effective, and aesthetic reconstructive option for patients with benign or previously treated jaw malignant tumors. This technique may provide rapid occlusal reconstruction and oral rehabilitation.

Antiangiogenic Effects of Infliximab in Chick Chorioallantoic Membrane Model

Introduction: TNF-α plays a key role in initiating pathologic angiogenesis, however, literature on the effects of infliximab on angiogenesis is limited.
 Objective: The study aimed to investigate the effects of infliximab on angiogenesis in an in vivo chick chorioallantoic membrane (CAM) model.
 Methods: The study was approved by the local ethics committee on animal experimentation. Thirty fertilized specific pathogen-free eggs were incubated and kept under appropriate temperature and humidity control. On the third day of the incubation, infliximab (1 µmol) dissolved in phosphate-buffered saline in the first group, phosphate-buffered saline (negative control) (0.1 ml) in the second group, anti-VEGF (positive control) (1 µmol) in the third group were administered by injection. On the eighth day of incubation, the vascular structures of the CAMs were macroscopically examined, and standard digital photographs were taken. The digital images were analyzed, and data including mean vessel density, thickness, and number were compared between groups. P < 0.05 was considered statistically significant.
 Results: Angiogenesis was significantly reduced in the anti-VEGF and infliximab groups compared to the saline-only group. Vessel thickness, vessel number, and vessel density were significantly less in the infliximab and anti-VEGF groups compared to the saline-only group (p=0.034, 0.029, 0.024, respectively).
 Conclusions: Infliximab showed promising antiangiogenic effects in the chick CAM model. Thus, infliximab could be a treatment agent in pathological processes in which angiogenesis is responsible. The antiangiogenic effect of infliximab could be due to the inhibition of various angiogenesis-related cytokines and adhesion molecules. Further studies are needed to clarify the exact mechanisms.

Operator dependence of methods for obtaining metric characteristics of a face with real measurements and digital images

BACKGROUND: No studies in the scientific literature have established the operator dependence of portrait identification with the manual method of measuring facial parameters in subjects compared with measurements from digital images. The labor costs and accuracy of the measurements with these methods have not been established.
 AIM: To establish the operator dependence of methods of real-face measurement and measurement on digital images.
 MATERIALS AND METHODS: Facial parameters were instrumentally measured in 24 Caucasian women aged 19–20 years who were studying at the Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University by four researchers independently of each other. The same type of standard digital photography of each subject’s face was taken in five projections, followed by a comparison of the results of real measurements with digital ones.
 RESULTS: When comparing the results of facial measurements obtained from digital images and manual method, an error was observed both in the measurements of one parameter by one researcher using two methods and in the excellent results obtained by other researchers. However, the greatest deviations were observed with the manual method, which may be due to the dependence of measurements on the operator.
 CONCLUSION: With a streamlined and methodically verified approach to working with digital facial images, this technique is more accurate and less labor-intensive than real measurements because of the absence of operator dependence, which can be used in investigating crimes.

Efficacy and Safety of Solid-state Dual-wavelength Lasers for the Treatment of Moderate-to-severe Inflammatory Acne in Asian Populations.

Standard treatments for moderate-to-severe acne often require oral medications but are not long-lasting or free from side effects. We aimed to evaluate the efficacy and safety of a solid-state dual-wavelength laser for moderate-to-severe inflammatory acne in an Asian population. Forty individuals with moderate-to-severe acne received nightly topical retinoids and two to three weekly treatments with a 1319-nm laser followed by a 589-nm laser (five sessions in total). Patients were evaluated at pretreatment baseline, at monthly intervals, and at 1 month after the last laser for pain, seborrhea, global aesthetic improvements, and satisfaction, using standardized digital photography and global assessment scales. Fifteen patients had an additional evaluation 3 months after the fifth session. At 1 month, all patients (n = 40) had improved inflammatory acne counts, with 72.5% having greater than 75% reduction in acne count, 7.5% having 51%-75% reduction, 17.5% having 26%-50% reduction and 2.5% having less than 25% reduction. Moreover, GAS evaluations showed that 62.5% of patients improved to almost clear and 37.5% to mild acne (P = 0.0478), while improvements were sustained in patients with 3-month follow-ups. Erythema (n = 29) improved with 65.5% of affected patients having greater than 75% reduction. Patients (n = 17) with pigmentation experienced lightening, with 52.9% of affected patients having a greater than 75% reduction. With low pain scores (mean 3.68 of 10, median 4 of 10), the treatment was well-tolerated. All patients (n = 40) reported acne improvements with 95% having much improved or very much improved, and 95% either satisfied or very satisfied. Dual-wavelength lasers effectively and safely treat moderate-to-severe inflammatory acne with high patient satisfaction. It is ideal for patients who refuse or are contraindicated to oral medications, and patients with acne-associated pigmentation, erythema and seborrhea.

Effect of Extent of White Spot Lesions on the Esthetic Outcome after Treatment by the Resin Infiltration Technique: A Clinical Trial.

Objectives: This study aimed to assess the effect of extent of white spot lesions (WSLs) on the esthetic outcome (masking effect and durability) for 6 months after treatment by the resin infiltration technique. Materials and Methods: In this clinical trial, 79 teeth with WSLs in 18 patients were selected. The lesions were assigned to localized and generalized groups, and were all treated by resin infiltration. The color of WSLs was assessed at baseline, immediately after treatment, and 1, 3, and 6 months after treatment by using Easy Shade spectrophotometer and taking standard digital photographs. The surface area of WSLs was calculated on the photographs using MIP4Student software. Repeated Measures ANOVA was used to compare color change (∆E), and the Pearson's correlation test was applied to analyze the association between the extent of lesions and ∆E (alpha=0.05). Results: A significant difference was found between the two groups in ∆E at different time points (P<0.05). Also, in both localized and generalized lesions, the pretreatment ∆E was significantly different from the ∆E values at different time points after treatment (P<0.001). However, the post-treatment ∆E values were not significantly different (P>0.05). The Pearson test showed an inverse correlation between the extent of lesions and ∆E (P<0.05). Conclusion: The resin infiltration technique is successful in masking the WSLs, with a durability of at least 6 months. Color correction by this technique is more favorable in localized lesions.

Tooth Color Differences between Digital Photography and Spectrophotometer in both Genders: An In vivo Study

Background: Tooth color is one of the most concerning issues in cosmetic dentistry. Different lighting, materials, and genders have influenced tooth color, hence, influencing the esthetic appearance. Knowing the differences between different materials to measure tooth color and differences in tooth color between genders could help in better understanding and choosing artificial tooth color. Objective: This study aims to compare two color-measuring methods, spectrophotometer and standardized digital photography, and gender differences in terms of tooth color. Methods: An evaluation of 300 vital maxillary central and lateral incisors was carried out on 150 adult participants. Tooth color was measured using the CIEL*a*b* color system on digital photography images and the Vita Easyshade spectrophotometer. The settings for digital photography were standardized, and the reliability of the method was tested. An independent sample t-test was used to compare the two color-measuring methods and gender differences in terms of tooth color, with a significant level set at p = 0.05. Results: There were statistically significant differences between Vita Easyshade Spectrophotometer and digital photography in all color spaces (L*, a*, and b*) for central and lateral incisors. There was a significant difference between males’ and females’ L* color space in digital photography for central (p = 0.04) and lateral (p = 0.05) incisors. The reliability of the digital photography method used in this study was high. Conclusion: Tooth colors were found to be lighter and more yellowish in VITA Easyshade compared to the digital camera. Females had lighter teeth compared to males in digital photography. The digital photography method showed excellent reliability.

Preliminary Results of Measurements of Frontal Plane Knee Alignment Using a Standardized, Sonographic-Assisted Digital Photograph—A Reliable and Accurate Alternative to a Full-Leg Radiograph?

(1) Clinical alternatives to the full-leg radiograph (FLR) for determining frontal plane lower limb alignment have shown mixed results so far concerning reliability and accuracy. In addition, intercondylar respectively intermalleolar distance (ICD/IMD) measurement is limited in the interpretation of its results. The purpose of the study is to present a standardized, sonographic-assisted photographic measurement (SPM) of the leg axis in the frontal plane using a digital photograph and compare it with the gold standard of the anterior–posterior FLR. (2) Adults who had recently received an FLR were included in the study. After determining the center of the hip joint and knee joint gap in a standing position via ultrasound, a standardized digital photograph was taken. Subsequently, the hip–knee–ankle angle (HKA) was measured using an image editing program for SPM and FLRs. Mean deviation (MD), Pearson’s correlation coefficient and the clinical method’s interclass correlation coefficient (ICC) were calculated. (3) Of 18 subjects (8 male and 10 female), respectively, 34 lower extremities have been included in the study. Their mean BMI was 25.5 kg/m2. The correlation between the two measurement methods for subjects with BMI &lt; 30 kg/m2 was reliably high (r = 0.93, p &lt; 0.001). The HKAs derived from SPM and FLRs showed a mean deviation (MD) of 2.4° (range 0.1–6.0°) for subjects with BMI &lt; 30 kg/m2. The average ICC among all examiners conducting the SPM was 0.99 (CI 0.95–0.99, p &lt; 0.001). The MD for subjects ≥ 30 kg/m2 increased significantly (MD = 5.5°; n = 10, p &lt; 0.001). (4) SPM of the leg axis in the frontal plane allows sufficiently accurate results in patients with a BMI lower than 30 kg/m2. The methodology is limited in cases of increased BMI and needs well-trained examiners. Nevertheless, as a screening method in the field of children and adolescents, this method can be recommended in clinical daily routine.

Playing Football as a Risk Factor for Lower Leg Malalignment?—Comparing Lower Leg Axis of Male Adolescent Football Players and Referees

The prevalence of varus knee malalignment among junior and adult football players (FP) has proven to be higher compared to other sports. No causal relationship has yet been found, as genu varum can be assumed to be an independent risk factor for the development of knee osteoarthritis. The purpose of this study is to compare knee alignment measurements and sport-specific data of adolescent football players and referees (REF). Knee alignment was detected by measuring the intercondylar/intermalleolar distance (ICD/IMD) as well as the Hip–Knee–Ankle angle (HKA) using a standardized digital frontal-plane photograph. Anthropometric and sports-related data (training/match exposure, seasons actively played, etc.) were collected by means of questionnaires (Clinical trial registration number: DRKS00020446). A total of 28 male FP and 29 male adolescent REF were included in the survey. The mean age was 17.4 ± 0.7 years. The two groups did not differ significantly in age, height, weight, BMI, and overall football/refereeing exposure per week (FP vs. REF: 274 vs. 285 min/week, p = 0.61). The HKA of the FP was significantly lower (toward varus) than that of the REF (177.6° ± 2.4° vs. 179.0° ± 2.4°; p &lt; 0.001). However, ICD did not significantly differ (FP: 17 ± 25 mm, REF: 13 ± 27 mm; p = 0.55). The football environment with frequent football exposure seems to have an influence on leg axis deviation in FP compared to REF. For prevention of knee osteoarthritis in FP, an advanced understanding of leg axis development in adolescent players is essential and, therefore, needs further research.

Comparison of Injection Meglumine Antimoniate with a Combination of Injection Meglumine Antimoniate and Carbon Dioxide Fractional Ablative Laser in Treatment of Cutaneous Leshmaniasis

Aim: To see the efficacy of meglumine antimoniate alone in comparison with combination of meglumine antimoniate and CO2 ablative laser among patients with cutaneous leishmaniasis. Study design: Quasi-experimental study. Place and duration of study: Department of Dermatology, Pakistan Emirates Military Hospital, Rawalpindi from 9th July 2020 to 8th January 2021. Methodology: Sixty patients (30 in each group) diagnosed cases of cutaneous leishmaniasis by skin biopsy or slit skin smear were enrolled. In group A; intramuscular injection of meglumine antimoniate (dose 20 mg/kg daily) was administered for 28 days and group B was treated with intramuscular meglumine antimoniate injection along with fractional C02 ablative laser. Standard digital photography was done before start of treatment and then every 2 weeks. Results: Efficacy of meglumine antimoniate alone was observed in 60% of patients while it was 86.7% when combined with fractional CO2 ablative laser. Better outcome was observed when such patients were treated with both meglumine antimoniate and fractional CO2 laser. Efficacy was measured after 6 x weeks in all patients of both groups. Clinical Implication: Hence CO2 lasers are latest modality of treatment with minimal side effects and can be used in treatment of patients with cutaneous leishmaniasis. Conclusion: Efficacy of meglumine antimoniate plus fractional CO2 laser found to be higher as compared to meglumine antimonate alone in treating cutaneous leishmaniasis. Keywords: Cutaneous leishmaniasis, CO2 fractional ablative laser, Meglumine antimoniate, Slit skin smear

Treatment of port wine stain by flash-lamp pulse-dye laser 595 nm

Introduction: Port wine stain (PWS) is one of the commonly encountered congenital cutaneous vascular lesions, with an equal sex distribution. Pulsed-dye lasers (PDL) have revolutionized the treatment of both congenital and acquired cutaneous vascular lesions. The pulsed dye laser owing to its superior efficacy and safety profile have become the appropriate choice for the management of port-wine stains. Aim: To evaluate the efficacy and side effects of pulse dye laser in the treatment of port wine stain. Patients and Methods: This is a prospective interventional therapeutic study, which was conducted at the Center of Dermatology and Venereology, Medical City in Baghdad/Iraq, from February 2020 to January 2022. Patients with port wine stain who attended the dermatology outpatient clinic were included in this study, their demography had been assessed, facial port wine area and severity index (FSASI) was done for their PWS and photos for documenting the results were taken. Pulse dye laser session was done for 30 patients for 3 to 10 sessions on monthly basis. Therapeutic outcomes were assessed by standardized digital photography. Results: A total of 26 patients completed the study, 17 (65, 4%) females and 9 (34, 6%) males. Age ranged from 3 to 62 years. Eight patients reported excellent improvement (76-99%), thirteen patients’ significant improvement (51-75%), five patients with moderate improvement (26-50%) in the appearance of the PWSs. Conclusions: Pulse dye laser is a good modality of treatment for PWS being a safe and effective option in Iraqi patients.

Effects of second-generation H1-antihistamine drugs on angiogenesis in in vivo chick chorioallantoic membrane model

Background Literature on the effects of second-generation H1-antihistamines on angiogenesis is limited. Objectives To investigate the effects of cetirizine, desloratadine, and rupatadine (second-generation H1-antihistamines commonly used in dermatology clinics) on angiogenesis in an in vivo chick chorioallantoic membrane (CAM) model. Methods The study was approved by the local ethics committee on animal experimentation. Forty fertilized specific pathogen free eggs were incubated and kept under appropriate temperature and humidity control. Drug solutions were prepared in identical concentrations by dissolving powders in phosphate-buffered saline (PBS). On the third day of the incubation, a small window was opened on the CAM and 0.1 mL desloratadine (1.5 μg/0.1 mL) in the first group, 0.1 mL cetirizine (1.5 μg/0.1 mL) in the second group, 0.1 mL rupatadine in the third group (1.5 μg/0.1 mL), and PBS (0.1 mL) in the fourth group were administered by injection. On the eighth day of incubation, the vascular structures of the CAMs were macroscopically examined and standard digital photographs were taken. The digital images were analyzed and data including mean vessel density, thickness, and number were compared between groups. p < 0.05 was considered statistically significant. Results Vessel densities were similar in the desloratadine, cetirizine, and control groups, whereas they were significantly less in the rupatadine group (p = 0.01). Furthermore, the rupatadine group had significantly lower vessel thickness and number compared with the other groups (p < 0.05 for both). Conclusions Rupatadine showed anti-angiogenic effects in the chick CAM model, compared with desloratadine and cetirizine. The anti-angiogenic effect of rupatadine could be due to its platelet-activating factor (PAF) receptor inhibition. Thus, rupatadine could be a treatment agent in pathological processes in which angiogenesis is responsible. Further studies with larger series are needed to clarify this potential.

EFFICACY OF NOVEL BIOACTIVE GLASS IN THE TREATMENT OF ENAMEL WHITE SPOT LESIONS: A RANDOMIZED CONTROLLED TRIAL✰

to evaluate the efficacy of 2 types of bioactive glass (45S5) compared to casein-phosphopeptide stabilized-amorphous calcium phosphate (CPP-ACP) in the treatment of orthodontically-induced white spot lesions (WSLs). Sixty post-orthodontic WSLs (ICDAS II score 2) were randomly allocated to a double blind randomized controlled trial with 3 parallel arms (n = 20). Test group I (Bio-BAG) received BiominF slurry and toothpaste, and test group II (N-BAG) received Novamin slurry and toothpaste. While the positive control group (CPP-ACP) received Recaldent paste. Products were applied daily in-office during week 1, and boosted by self-administered home application for 4 weeks (week 1-4). Standard oral hygiene care was performed by all participants twice daily during months 2-6. All patients were assessed for change in WSL dimensions using computer assisted analysis based on standardized digital intraoral photographs in addition to laser fluorescence DIAGNOdent assessment before treatment (T0) and at 1 week (T1), 1 month (T2), 3 months (T3,) and 6 months (T4) follow up periods. Kruskal Wallis test was used (P < .05 for all). At T4, a statistically significant (P < .001) regression of WSL was disclosed in all 3 groups compared to baseline, and a highly significant lesion size percent reduction in Bio-BAG group compared to the control group (P < .001). The mean area of the lesions decreased by 64.8%, 32.2%, and 31.6% for groups I, II and III respectively (P = .001). DIAGNOdent findings largely reflected the clinical scores (Mean scores at baseline/T4 for groups I, II, and III respectively; 16.57/3.62, 16.93/7.90, 21.95/19.27). No adverse effects were reported. The combined in-office and home-application of BiominF paste for 4 weeks resulted in greater esthetic improvements of post-orthodontic WSLs compared to Novamin and CPP-ACP. In addition, BiominF showed a significant reduction in fluorescence intensity which indicates potential lesion remineralization. Post-orthodontic WSLs can be diminished using bioactive glass remineralization therapy.

Study of Fractional Carbon Dioxide Laser in Treatment of Onychomycosis (100 Cases)

Background: Onychomycosis is a fungal infection of nail unit. Tinea unguium is dermatophytic nail infection. common dermatophytes causing onychomycosis is Trichophyton rubrum. Onychomycosis increase in frequency with age, amongst them adult males are more frequently affected than females. There are various topical and systemic antifungal agents available for onychomycosis. Despite this it is difficult to treat onychomycosis as higher local concentration of drug is required for clearing the infection and it is difficult to achieve. Aim and objectives: To ascertain efficacy of fractional carbon dioxide laser in onychomycosis. To evaluate fractional carbon dioxide laser's effectiveness in total clearance of onychomycosis from nails. Materials and methods: Methods: 100 patients of clinically diagnosed onychomycosis were selected. All patient’s KOH smear examination was done by collecting samples from scrapings of nail material. All patients were given systemic antifungals along with topical antifungals. Laser sittings had been done at an interval of 1 month. Total 6 monthly sittings were done. Topical lignocaine hydrochloride 2% w/v gel were applied for 20-30minutes before giving laser therapy. Standard digital photographs were taken before initiating the therapy and then repeated monthly. After completion of 6 months all patients were followed up for 9 months with an interval of 3 and 6 months. Results: At 6 months after completion of 6 sittings of CO2 laser 68 patients had complete response, 16 patients had significant response, 8 patients had moderate response, 8 patients had no response at 6 months of therapy. Limitations: Small population size, absence of control group, mycological culture was not performed were the main limitations of our study. Conclusion: Fractional carbon dioxide laser is effective in treating onychomycosis along with topical and systemic antifungals and it has minimal side effects. Keywords: Onychomycosis, fractional carbon dioxide (CO2) laser.

A Comparative Study of Therapeutic Efficacy of BCG Immunotherapy (50 Cases) and Vitamin D (50 Cases) in Cutaneous Warts (Total 100 Cases)

Background: Human papilloma virus infects the epithelium of skin or mucosal cells to cause warts. Most of the current therapeutic modalities are ablative, act only on targeted lesions, and lack a well-defined treatment endpoint. These procedures have high recurrence rates, side effects and are not effective over distant warts. Intralesional immunotherapy acts on cell mediated immunity to treat local as well as distant lesions. Aims and objectives: To evaluate the efficacy and safety of intralesional BCG and intralesional VITAMIN D and to compare efficacy and safety of intralesional BCG and intralesional VITAMIN D in the treatment of patients with cutaneous warts. Materials and Methods: This study included 100 adult patients with single or multiple warts of different size, number and duration with or without distance warts. Each patient was randomly assigned into Group 1 (BCG : 0.1mL of 1mg/mL) and Group 2 (vitamin D3 : 0.2mL of 15mg/mL). One or two warts were injected per session at interval of 21 days for three sessions. Response was assessed. Adverse effects were noted. Cases were further followed up after 3 months without any treatment to assess for any recurrences. In both the groups, standard medical treatment will be also given. Standard digital photographs were taken at each visit to support the data. Results: The BCG group had the maximum patients with complete response (36 of 50, 72%) followed by VITAMIN D group (24 of 50, 48%). No major adverse drug reactions were reported in any of the group. Limitations: Small sample size and absence of control group were the main limitations of our study. Conclusion: Immunotherapy offers a safe, effective and affordable approach in the patients with multiple cutaneous viral warts with lesser side effects and recurrence rate. Keywords: BCG, VITAMIN D, WARTS

A Comparative Study of Combined Effect of Dermaroller and Topical Tacrolimus (50 Cases) vs Topical Tacrolimus Alone (50 Cases) in Patients of Stable Vitiligo (Total 100 Cases)

Background: Vitiligo is an autoimmune disease produced as a result of interaction of environmental, genetic, neural factors, leading to the destruction of melanocytes and appearance of depigmented macules. It is a chronic disease of great cosmetic concern. As it is often recalcitrant to medical treatment alone, many surgical techniques are used to treat stable vitiligo. Aims and objectives: To evaluate the efficacy and safety of combined dermaroller and topical tacrolimus versus topical tacrolimus alone treatment in the patients of stable vitiligo. Materials and Methods: Material:Dermaroller specification :192needles, 1.5 mm diameter Method: Patients were randomly assigned into two groups of 50 patients each. Group A received treatment with dermaroller followed by topical tacrolimus whereas Group B received treatment with topical tacrolimus alone. In both the groups, standard medical treatment was also given. Standard digital photographs were taken at each visit to support the data. Results: The dermaroller group showed maximum patients with excellent response in 44% cases as compared to topical tacrolimus alone group which showed excellent response in 24% cases. Limitations: small sample size and absence of control group were the main limitations of our study. Conclusion: Dermaroller is safe and effective tool for repigmentation in vitiligo with minimum side effects for transdermal drug delivery. Keywords: Vitiligo, Dermaroller, Tacrolimus

Visual Inspection for Lower Limb Malalignment Diagnosis Is Unreliable.

Visual inspection of the lower limb is often part of standard clinical practice during a physical examination at the outpatient clinic. This study aims to investigate how reliable visual inspections are in terms of detecting lower limb malalignments without additional tools and physical examinations. This study enrolled 50 patients. Each patient underwent a whole leg radiograph (WLR); in addition, a standardized digital photograph was taken of the lower limbs. Four persons (different experience levels) visually rated the digital photograph twice (unaware of the hip knee angle [HKA] on the WLR) and placed them in the category: severe valgus (>5°); moderate valgus (2°-5°); neutral, moderate varus (2°-5°); and severe varus (>5°). Visual ratings were compared with the measured HKA on WLRs for correlation using Spearman's rho. Linear ordinal regression models with significance when P < 0.05 were used to test whether body mass index (BMI), age, gender, and HKA were possible risk factors for incorrect visual HKA assessment. Spearman's rho between the visual assessment and measured HKA on the WLR was moderate with 0.478 (P < 0.01). Women had an increased odds ratio of 3.7 (P = 0.001) for incorrect visual assessment. Higher HKA also increased the odds ratio for erroneous visual assessment with 1.4 (P = 0.003). BMI and age did not significantly increase the odds of erroneous visual leg axis assessments in this study. Visual assessment of the lower limb alignment does not provide clinically relevant information. Lower limb malalignment diagnoses cannot be performed using only a visual inspection. Physical examination tests and radiographical assessments are advised. Diagnostic level II.

Evaluation of tooth eruption rate of incisor teeth in rats with estrogen deficiency.

To assess the influence of estrogen deficiency on tooth eruption rate (TER) and gene expression of estrogen receptor alpha and beta (ERα and ERβ) in the odontogenic region of teeth with continuous formation in a rat model. Ovariectomies (OVX; n = 25) and sham surgeries (SHAM; n = 25) were performed in female Wistar rats when animals were 25days old. The TER of the lower incisors, both in impeded (hyperfunction condition) and unimpeded (trimmed incisal edge-hypofunction condition) conditions, was evaluated using standardized digital photographs acquired every 48-72h for 3weeks (35th-53rd day of life), using a camera coupled to a stereomicroscope. Quantitative real-time PCR was performed to evaluate the relative gene expression of ERα and ERβ in the odontogenic region. The OVX group showed a significant reduction in TER when compared to the SHAM group, only in the impeded condition (p = 0.03). There was no statistically significant difference between the groups in ERα gene expression (p = 0.33). ERβ showed a significantly higher gene expression in the OVX group (p ≤ 0.05). Estrogen deficiency decreases TER in teeth under impeded condition. Estrogen deficiency also increases ERβ gene expression in the odontogenic region of teeth with continuous formation. Hormonal disturbances affecting estrogen levels can cause alterations in dental formation and teeth eruption.

Prediction of the risk of cancer and the grade of dysplasia in leukoplakia lesions using deep learning

ObjectivesTo estimate the probability of malignancy of an oral leukoplakia lesion using Deep Learning, in terms of evolution to cancer and high-risk dysplasia. Materials and MethodsA total of 261 oral leukoplakia lesions with a mean of 5.5 years follow-up were analysed from standard digital photographs. A deep learning pipeline composed by a U-Net based segmentation of the lesion followed by a multi-task CNN classifier was used to predict the malignant transformation and the risk of dysplasia of the lesion. An explainability heatmap is constructed using LIME in order to interpret the decision of the model for each output. ResultsA Dice coefficient of 0.561 was achieved on the segmentation task. For the prediction of a malignant transformation, the model provided a sensitivity of 1 with a specificity of 0.692. For the prediction of high-risk dysplasia, the model achieved a specificity of 0.740 and a sensitivity of 0.928. ConclusionThe proposed model using deep learning can be a helpful tool for predicting the possible malignant evolution of oral leukoplakias. The generated heatmap provides a high confidence on the output of the model and enables its interpretability.

A Study on Digital Color Reproduction for Recording Color Appearance of Cultural Heritage

The color appearance of cultural heritage are essential factors for manufacturing technique interpretation, conservation treatment usage, and condition monitoring. Therefore, this study systematically established color reproduction procedures based on the digital color management system for the portrait of Gwon Eungsu. Moreover, various application strategies for recording and conserving the cultural heritage were proposed. Overall color reproduction processes were conducted in the following order: photography condition setting, standard color measurements, digital photography, color correction, and color space creation. Therefore, compared with the color appearance, the digital image applied to a camera maker profile indicated an average color difference of Δ10.1. However, the digital reproduction result based on the color management system exhibits an average color difference of Δ1.1, which is close to the color appearance. This means that although digital photography conditions are optimized, recording the color appearance is difficult when relying on the correction algorithm developed by the camera maker. Therefore, the digital color reproduction of cultural heritage is required through color correction and color space creation based on the raw digital image, which is a crucial process for documenting the color appearance. Additionally, the recording of color appearance through digital color reproduction is important for condition evaluation, conservation treatment, and restoration of cultural heritage. Furthermore, standard data of imaging analysis are available for discoloration monitoring.