Search

Background ChatGPT is an open-access chatbot developed using artificial intelligence (AI) that generates human-like responses. Objective To evaluate the ChatGPT-4's concordance with three dermatological surgeons on reconstructions for dermatological surgical defects. Methods The cases of 70 patients with nonmelanoma skin cancer treated with surgery were obtained from clinical records for analysis. A list of 30 reconstruction options was designed by the main authors that included primary closure, secondary skin closure, skin flaps and skin grafts. Three dermatological surgeons who were blinded to the real reconstruction, along with ChatGPT-4, were asked to select two reconstruction options from the list. Results Seventy responses were analysed using Cohen's kappa, looking for concordance between each dermatologist and ChatGPT. The level of agreement among dermatological surgeons was higher compared with that between dermatological surgeons and ChatGPT, highlighting differences in decision making. In the selection of the best reconstruction technique, the results indicated a fair level of agreement among the dermatologists, ranging between κ 0.268 and 0.331. However, the concordance between ChatGPT-4 and the dermatologists was slight, with κ values ranging from 0.107 to 0.121. In the analysis of the second-choice options, the dermatologists showed only slight agreement. In contrast, the level of concordance between ChatGPT-4 and the dermatologists was below chance. Conclusions As anticipated, this study reveals variability in medical decisions between dermatological surgeons and ChatGPT. Although these tools offer exciting possibilities for the future, it is vital to acknowledge the risk of inadvertently relying on noncertified AI for medical advice. [ABSTRACT FROM AUTHOR]

Major depressive disorder (MDD) and obesity have a complex bidirectional relationship. However, most studies do not assess increased appetite or weight as a depressive symptom due to limitations in rating scales. Here we aimed to analyze frequently employed depressive-symptom scales and discuss the relevance of weight and appetite assessment items. To elaborate this perspective, we searched for validated questionnaires and scales evaluating depressive symptoms in English. We analyzed appetite and weight items from 20 depressive-symptoms rating scales. Only 8 of 20 rating scales assessed for increased weight or appetite. The scales reported in the literature as the most employed in antidepressants efficacy trials do not assess increased appetite or weight. The current use of rating scales limits our understanding of the relationship between MDD, antidepressants, and obesity. It is necessary to improve our weight and appetite measurements in MDD to clarify the respective impact of depressive symptoms and antidepressants on weight change. [ABSTRACT FROM AUTHOR]

Background: Ketamine is increasingly used for treatment‐resistant depression (TRD) while its mechanism of action is still being investigated. In this systematic review, we appraise the current evidence of metabolomic biomarkers for racemic ketamine and esketamine in patients with TRD and healthy controls (HCs). Methods: A comprehensive search of several databases (Ovid MEDLINE®, Embase, and Epub Ahead of Print) was performed from each database's inception to June 29, 2022, in any language, was conducted. We included studies wherein the metabolomic biomarkers for racemic ketamine or esketamine were investigated in TRD or HCs. Our main outcomes were to examine changes in metabolites among patients treated with ketamine/esketamine and explore the association with response to ketamine/esketamine. Results: A total of 1859 abstracts were screened of which 11 were included for full‐text review. Of these, a total of five articles were included (N = 147), including three RCTs (n = 129) and two open‐label trials (n = 18). All studies used racemic ketamine; one study additionally used esketamine. The included studies evaluated patients with treatment‐resistant bipolar depression (n = 22), unipolar depression (n = 91), and HCs (n = 34). The included studies reported alteration in several metabolites including acylcarnitines, lipids, kynurenine (KYN), and arginine with ketamine in TRD. Studies suggest the involvement of energy metabolism, KYN, and arginine pathways. In HCs, acetylcarnitine decreased post‐infusion, whereas inconsistent findings were observed after the ketamine infusion in TRD patients. Conclusions: This systematic review provides preliminary evidence that ketamine may cause changes in several important pathways involved in energy metabolism and inflammation. Larger and more rigorous studies are needed. [ABSTRACT FROM AUTHOR]

This article discusses a clinical trial that investigated the efficacy of combining NB-UVB phototherapy with oral vitamin D supplementation in patients with generalized vitiligo. The trial involved 26 participants, with 15 completing all visits due to the COVID-19 pandemic. The results showed that both the intervention group (vitamin D supplementation + NB-UVB phototherapy) and the placebo group (placebo + NB-UVB phototherapy) experienced improvements in the Vitiligo Area Severity Index (VASI) at 24 weeks. However, there was no significant difference between the two groups. The study suggests that oral vitamin D supplementation may not be effective in combination with phototherapy for treating vitiligo. [Extracted from the article]

Lithium has been a cornerstone treatment for bipolar disorder (BD). Despite descriptions in the literature regarding associations between long-term lithium therapy (LTLT) and development of a thyroid disorder (overt/subclinical hypo/hyperthyroidism, thyroid nodule, and goiter) in BD, factors such as time to onset of thyroid abnormalities and impact on clinical outcomes in the course of illness have not been fully characterized. In this study we aimed to compare clinical characteristics of adult BD patients with and without thyroid disorders who were on LTLT. We aimed to identify the incidence of thyroid disorders in patients with BD on LTLT and response to lithium between patients with and without thyroid disorders in BD. The Cox proportional model was used to find the median time to the development of a thyroid disorder. Our results showed that up to 32% of patients with BD on LTLT developed a thyroid disorder, of which 79% developed hypothyroidism, which was corrected with thyroid hormone replacement. We did not find significant differences in lithium response between patients with or without thyroid disorders in BD. Findings from this study suggest that patients with BD and comorbid thyroid disorders when adequately treated have a response to lithium similar to patients with BD and no thyroid disorders. [ABSTRACT FROM AUTHOR]

A 22-year-old male with human immunodeficiency virus (HIV) infection presented to the outpatient clinic in March 2021 with an 8-month history of multiple nodular lesions on the upper and lower limbs. Granulomatous secondary syphilis may resemble all these differential diagnoses, as they can have a similar clinical presentation with red-purple macules, papules, plaques, tumors, and nodules. The classic cutaneous presentation of secondary syphilis is a symmetrical non-tender macular rash, erythematous or copper-colored, on the trunk, extremities, palms, and soles.[1] Nevertheless, secondary syphilis has a highly versatile cutaneous presentation; a more aggressive or atypical presentation has been reported among patients with HIV infection.[2] Granulomatous infiltration is a rare finding in secondary syphilis, with few cases reported in the literature. [Extracted from the article]

Eosinophilic fasciitis (EF) is an uncommon autoimmune connective tissue disorder characterized by edema, erythema, and subsequent induration of the extremities. It is commonly treated with corticosteroids but there is no treatment ladder for immunosuppressants or steroid-sparing agents. We report two EF cases treated effectively with mycophenolate mofetil (MMF) or mycophenolic acid (MPA) and present a literature review. We performed a MEDLINE search using the keywords 'eosinophilic fasciitis', 'Shulman syndrome', 'mycophenolic acid', or 'mofetil mycophenolate', and found 8 articles with 27 cases in which MMF or MPA was used. Twenty-nine cases were reviewed (2 reported herein and 27 from the literature search); all patients received a combination of systemic corticosteroids and MMF. MMF/MPA were given as a steroid-sparing agent in 27 (93.1%), in 1 (3.4%) as adjunctive therapy with other immunosuppressants, and in one, as monotherapy 1 (3.4%). Nineteen had a complete response, 6, a partial response, and 2 were unresponsive to diverse immunomodulators; in 2 cases, the outcome was not reported. MMF and MPA show promising therapeutic results and could be a treatment option to reduce corticosteroid related side effects. [ABSTRACT FROM AUTHOR]

Background: Bipolar disorder (BD) with co-occurring attention deficit-hyperactivity disorder (ADHD) is associated with an unfavorable course of illness. We aimed to identify potential clinical and genetic correlates of BD with and without ADHD. Methods: Among patients with BD (N = 2,198) enrolled in the Mayo Clinic Bipolar Biobank we identified those with ADHD diagnosed in childhood (BD+cADHD; N = 350), those with adult-onset attention deficit symptoms (BD+aAD; N = 254), and those without ADHD (N = 1,594). We compared the groups using linear or logistic regression adjusting for age, sex, and recruitment site. For genotyped patients (N = 1,443), logistic regression was used to compare ADHD and BD polygenic risk scores (PRSs) between the BD groups, as well as to non-BD controls (N = 777). Results: Compared to the non-ADHD BD group, BD+cADHD patients were younger, more often men and had a greater number of co-occurring anxiety and substance use disorders (all p < 0.001). Additionally, BD+cADHD patients had poorer responses to lithium and lamotrigine (p = 0.005 and p = 0.007, respectively). In PRS analyses, all BD patient subsets had greater genetic risk for BD and ADHD when compared to non-BD controls (p < 0.001 in all comparisons). BD+cADHD patients had a higher ADHD-PRS than non-ADHD BD patients (p = 0.012). However, BD+aAD patients showed no evidence of higher ADHD-PRS than non-ADHD BD patients (p = 0.38). Conclusions: BD+cADHD was associated with a greater number of comorbidities and reduced response to mood stabilizing treatments. The higher ADHD PRS for the BD+cADHD group may reflect a greater influence of genetic factors on early presentation of ADHD symptoms. [ABSTRACT FROM AUTHOR]

This article, titled "Editorial: Break the mental health stigma: bipolar disorder," discusses the stigma surrounding bipolar disorder and the need for targeted interventions to address this issue. The authors highlight the complex nature of bipolar disorder, which is characterized by multiple mood episodes and can lead to significant dysfunction in various aspects of a person's life. The article also explores the role of cognitive dysfunction in stigma and the importance of understanding the impact of race and personal religious beliefs on the disease process. Overall, the research topic aims to provide deeper insights into stigma in bipolar disorder and pave the way for further research in this area. [Extracted from the article]

Aims: Long‐term lithium therapy (LTLT) has been associated with kidney insufficiency in bipolar disorder (BD). We aimed to investigate the risk factors of chronic kidney disease (CKD) development and progression among BD patients receiving LTLT. Methods: We included adult patients with BD on LTLT (≥1 year) who were enrolled in the Mayo Clinic Bipolar Biobank, Rochester, Minnesota. We reviewed electronic medical records to extract information related to lithium therapy and kidney‐related data to assess changes in the estimated glomerular filtration rate (eGFR). CKD severity was assessed based on eGFR. Results: Among 154 patients who received LTLT, 41 patients (27%) developed CKD, of whom 20 (49%) patients continued lithium (continuers) and 19 (46%) discontinued it (discontinuers). The median time to stage 3 CKD development was 21.7 years from the start of Li treatment. Type‐2 diabetes mellitus and benzodiazepine use were independent predictors for CKD development in the survival analysis, after controlling for age. The subsequent CKD progression rate did not differ between continuers and discontinuers (mean GFR 48.6 vs. 44.1, p = 0.13) at the end of follow‐up duration (mean duration: 3.5 ± 4.4 years for continuers and 4.9 ± 5.3 years for discontinuers). Conclusion: CKD was observed in one fourth of patients with BD receiving LTLT. There was no significant difference in the progression of CKD among Li continuers versus discontinuers, at the mean follow‐up duration of 4.2 years, after the CKD diagnosis. Progression of CKD could be influenced by existing comorbidities and may not necessarily be due to lithium alone. [ABSTRACT FROM AUTHOR]

This article, published in the British Journal of Dermatology, discusses a case of furuncular myiasis caused by Dermatobia hominis in a 27-year-old man who had recently returned from the Amazon. The patient presented with a furuncle-like nodule in the temporal region that had a sensation of movement. Dermoscopy revealed a central opening with a creamy-white body surrounded by dilated vessels, and the larva had bird's-feet-like structures representing the breathing spiracles. The article highlights the value of entodermoscopy as a noninvasive tool for diagnosing this tropical parasitosis. [Extracted from the article]

Objective: Our aim was to evaluate the relationship between evening chronotype, a proxy marker of circadian system dysfunction, and disordered eating behavior and poor dietary habits in individuals with bipolar disorder (BD). Methods: In this cross‐sectional study, we evaluated 783 adults with BD. Chronotype was determined using item 5 from the reduced Morningness‐Eveningness Questionnaire. The Eating Disorder Diagnostic Scale (EDDS) and the Rapid Eating Assessment for Participants—Shortened Version (REAP‐S) were used to assess disordered eating behavior and dietary habits respectively. General linear models and logistic regression models were utilized to evaluate differences between chronotype groups. Results: Two hundred and eight (27%) BD participants self‐identified as having evening chronotypes. Compared to non‐evening types, evening types were younger (P < 0.01) and, after controlling for age, had higher mean EDDS composite z‐scores (P < 0.01); higher rates of binge‐eating (BE) behavior (P = 0.04), bulimia nervosa (P < 0.01), and nocturnal eating binges (P < 0.01); and a higher body mass index (P = 0.04). Compared to non‐evening types, evening chronotypes had a lower REAP‐S overall score (P < 0.01) and scored lower on the 'healthy foods' and 'avoidance of unhealthy food' factors. Evening types also skipped breakfast more often (P < 0.01), ate less fruit (P = 0.02) and vegetables (P = 0.04), and consumed more fried foods (P < 0.01), unhealthy snacks (P = 0.02), and soft drinks (P = 0.01). Conclusions: Our findings suggest that the circadian system plays a role in the disordered eating and unhealthy dietary behaviors observed in BD patients. The circadian system may therefore represent a therapeutic target in BD‐associated morbidity that warrants further investigation. [ABSTRACT FROM AUTHOR]

Background: Peripheral gene expression of several molecular pathways has been studied in major depressive disorder (MDD) with promising results. We sought to investigate some of these genes in a treatment-free Latino sample of Mexican descent. Material and Methods: The sample consisted of 50 MDD treatment-free cases and 50 sex and age-matched controls. Gene expression of candidate genes of neuroplasticity (BDNF, p11, and VGF), inflammation (IL1A, IL1B, IL4, IL6, IL7, IL8, IL10, MIF, and TNFA), the canonical Wnt signaling pathway (TCF7L2, APC, and GSK3B), and mTOR, was compared in cases and controls. RNA was obtained from blood samples. We used bivariate analyses to compare subjects versus control mean mRNA quantification of target genes and lineal regression modelling to test for effects of age and body mass index on gene expression. Results: Most subjects were female (66%) with a mean age of 26.7 (SD 7.9) years. Only GSK3B was differentially expressed between cases and controls at a statistically significant level (p = 0.048). TCF7L-2 showed the highest number of correlations with MDD-related traits, yet these were modest in size. Discussion: GSK3B encodes a moderator of the canonical Wnt signaling pathway. It has a role in neuroplasticity, neuroprotection, depression, and other psychiatric phenotypes. We found that adding population diversity has the potential to elicit distinct peripheral gene expression markers in MDD and MDD-related traits. However, our results should only be considered as hypothesis-generating research that merits further replication in larger cohorts of similar ancestry. [ABSTRACT FROM AUTHOR]

Background: Mycetoma is a chronic, granulomatous infection of subcutaneous tissue, that may involve deep structures and bone. It can be caused by bacteria (actinomycetoma) or fungi (eumycetoma). There is an epidemiological association between mycetoma and the environment, including rainfall, temperature and humidity but there are still many knowledge gaps in the identification of the natural habitat of actinomycetes, their primary reservoir, and their precise geographical distribution. Knowing the potential distribution of this infection and its ecological niche in endemic areas is relevant to determine disease management strategies and etiological agent habitat or reservoirs. Methodology/principal findings: This was an ambispective descriptive study of 31 patients with actinomycetoma. We determined the biophysical characteristics including temperature, precipitation, soil type, vegetation, etiological agents, and mapped actinomycetoma cases in Northeast Mexico. We identified two disease cluster areas. One in Nuevo Leon, with a predominantly kastanozems soil type, with a mean annual temperature of 22°, and a mean annual precipitation of 585.2 mm. Herein, mycetoma cases were produced by Actinomadura pelletieri, Actinomadura madurae, Nocardia brasiliensis, and Nocardia spp. The second cluster was in San Luis Potosí, where lithosols soil type predominates, with a mean annual temperature of 23.5° and a mean annual precipitation of 635.4 mm. In this area, all the cases were caused by N. brasiliensis. A. madurae cases were identified in rendzinas, kastanozems, vertisols, and lithosols soils, and A. pelletieri cases in xerosols, kastanozems, and rendzinas soils. Previous thorn trauma with Acacia or Prosopis plants was referred by 35.4% of subjects. In these states, the presence of thorny plants, such as Acacia spp., Prosopis spp., Senegalia greggi, Vachellia farnesiana and Vachellia rigidula, are common. Conclusions/significance: Mapping this neglected tropical infection aids in the detection of disease cluster areas, the development of public health strategies for early diagnosis and disease prediction models; this paves the way for more ecological niche etiological agent research. [ABSTRACT FROM AUTHOR]

Author summary: Patients who are immunocompromised or have cognitive or physical disabilities are at a higher risk of being affected with infections such as crusted scabies. This is a rare skin hyperinfestation by Sarcoptes scabiei var. hominis. The main characteristic of this dermatosis is a thick crust due to the high concentration of mites; in addition, other manifestations such as papules, excoriations, and burrows may be absent. In severe cases, thick yellow-brown crusts and plaques with deep fissures are present. Diagnosis can be made by observing mites, ova, or feces from skin scrapings. Multiple therapies can be used in patients with this condition. Management with patient isolation is important to prevent institutional outbreaks. This disease can have high mortality, primarily due to sepsis. Awareness of this condition and its serious consequences is important to reduce its mortality and morbidity. [ABSTRACT FROM AUTHOR]

Alopecia areata (AA) is an autoimmune disease of the hair follicle. Keratinocytes of the hair follicle generate an immunosuppressive environment by the local secretion of hormones of the hypothalamic‐pituitary‐adrenal axis of the skin (skin HPA analog). Our objective was to measure the local production of corticotropin‐releasing hormone (CRH), adrenocorticotropic hormone (ACTH), and α‐melanocyte‐stimulating hormone (α‐MSH) in the scalp tissue of patients with AA before and after ultraviolet A1 (UVA‐1) phototherapy to determine their role in the pathogenesis of AA and the effect of UVA‐1 on the AA hormonal environment. This was a retrospective and descriptive study of skin samples from 22 patients with AA before and after UVA‐1 treatment. We compared the changes in the local hormonal environment by measuring CRH, ACTH, type 2 melanocortin receptor (ACTH receptor) and α‐MSH with immunohistochemical stains. The positivity of MSH was significantly higher (P =.037) in the post‐treatment samples compared with the baseline value. ACTH was significantly higher in intensity (P =.032) in the post‐treatment samples compared with the initial value. CRH was significantly higher in intensity (P =.013) in baseline samples compared with the final biopsies. The positivity of the ACTH receptor MC2R was not different between the two groups (P =.626). In AA, an interruption in the signalling of CRH could decrease the local concentration of ACTH and MSH, and consequently, the immunosuppressive effect of these hormones. This phenomenon is normalized in the skin treated with UVA‐1. A defective signalling system in the cutaneous HPA axis may be involved in the pathogenesis of AA. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the efficacy and safety of the dopaminergic‐enhancing agent modafinil/armodafinil (MoArm) as adjunctive treatment for bipolar depression. Methods: A comprehensive search of major electronic databases was conducted to identify randomized controlled trials (RCTs) of adjunctive MoArm that included patients with bipolar I (BP‐I) or bipolar II (BP‐II) depression. Data for response/remission and all‐cause discontinuation were analyzed. Effect size was summarized by relative risk (RR) using a random effect model. Results: Of 58 studies, five RCTs (N = 795 drug, N = 792 placebo) met inclusion criteria. Four armodafinil studies included only BP‐I patients and one modafinil study included both bipolar subtypes with limited heterogeneity (I2 = 34%, P =.19; I2 = 18%, P =.30). Compared to placebo, augmentation with MoArm was associated with significantly greater rates of treatment response (RR, 1.18; 95% CI, 1.01‐1.37; P =.03) and remission (RR, 1.38; 95% CI, 1.10‐1.73; P =.005). All‐cause discontinuation was not different than placebo (RR, 1.08; 95% CI, 0.89‐1.30; P =.45) with no evidence of increased risk of mood switch or suicide attempts with MoArm (RR, 0.99; 95% CI, 0.39‐2.5; P =.98; RR, 1.02; 95% CI, 0.37‐2.85; P =.97). Conclusion: This narrower scope meta‐analysis of one drug for one disease suggests that adjunctive MoArm may represent a novel therapeutic intervention. Further studies delineating the subtypes of bipolar depression responsive to these novel dopaminergic‐enhancing agents are encouraged. [ABSTRACT FROM AUTHOR]

Background: Mycetoma is a neglected tropical disease characterized by nodules, scars, abscesses, and fistulae that drain serous or purulent material containing the etiological agent. Mycetoma may be caused by true fungi (eumycetoma) or filamentous aerobic bacteria (actinomycetoma). Mycetoma is more frequent in the so-called mycetoma belt (latitude 15° south and 30° north around the Tropic of Cancer), especially in Sudan, Nigeria, Somalia, India, Mexico, and Venezuela. The introduction of new antibiotics with fewer side effects, broader susceptibility profiles, and different administration routes has made information on actinomycetoma treatment and outcomes necessary. The objective of this report was to provide an update on clinical, therapeutic, and outcome data for patients with actinomycetoma attending a reference center in northeast Mexico. Methodology/principal findings: This was a retrospective, cross-sectional, descriptive study of 31 patients (male to female ratio 3.4:1) diagnosed with actinomycetoma by direct grain examination, histopathology, culture, or serology from January 2009 to September 2018. Most lesions were caused by Nocardia brasiliensis (83.9%) followed by Actinomadura madurae (12.9%) and Actinomadura pelletieri (3.2%). About 50% of patients had bone involvement, and the right leg was the most commonly affected region in 38.7% of cases. Farmers/agriculture workers were most commonly affected, representing 41.9% of patients. The most commonly used treatment regimen was the Welsh regimen (35.5% of cases), a combination of trimethoprim/sulfamethoxazole (TMP/SMX) plus amikacin, which had a 90% cure rate, followed by TMP/SMX plus amoxicillin/clavulanic acid in 19.4% of cases with a cure rate of 100%. In our setting, 28 (90.3%) patients were completely cured and three (9.7%) were lost to follow-up. Four patients required multiple antibiotic regimens due to recurrences and adverse effects. Conclusions/significance: In our sample, actinomycetoma was predominantly caused by N. brasiliensis. Most cases responded well to therapy with a combination of TMP/SMX with amikacin or TMP/SMX and amoxicillin/clavulanic acid. Four patients required multiple antibiotics and intrahospital care. Author summary: Mycetoma is a chronic skin disease that can invade bone or underlying organs. Inadequate treatment may lead to long-lasting disability. Information about treatment is scarce. We report the outcomes of 31 patients with a diagnosis of bacterial actinomycetoma attending a tertiary care hospital in northeast Mexico. Most cases were treated with a combination of antibiotics including TMP/SMX plus amikacin or TMP/SMX plus amoxicillin/clavulanic acid. Cure was achieved in 90% of patients and only one required surgery. [ABSTRACT FROM AUTHOR]

(a) Urticarial rash; (b) Pityriasis rosea-like eruption; (c) Varicelliform rash; (d and e) Maculopapular rash; (f) Pernio-like lesions; (g) Extensor surface rash involving the knees; (h) Flexor surface rash involving the antecubital fossa gl In accordance with other COVID-19 dermatologic registries, the most common skin manifestations were urticaria and maculopapular eruptions.2 We highlight an unusually high number of cases with varicella-like eruptions, flexural rash similar to the one presented in symmetrical drug-related intertriginous and flexural exanthema (SDRIFE), extensor surface rash, alopecia, and enanthem. Dear Editor, The COVID-19 pandemic continues its impact worldwide. The most common manifestations were urticaria in 40 (24.4%), maculopapular eruption in 28 (23.2%), varicella-like eruption in 25 (15.2%), enanthema in 13 (7.9%), and a pernio-like eruption in 11 (6.7%). [Extracted from the article]

Introduction: Clinical and genetic study of psychiatric conditions has underscored the co-occurrence of complex phenotypes and the need to refine them. Bipolar Disorder (BD) and Binge Eating (BE) behavior are common psychiatric conditions that have high heritability and high co-occurrence, such that at least one quarter of BD patients have BE (BD + BE). Genetic studies of BD alone and of BE alone suggest complex polygenic risk models, with many genetic risk loci yet to be identified. Areas covered: We review studies of the epidemiology of BD+BE, its clinical features (cognitive traits, psychiatric comorbidity, and role of obesity), genomic studies (of BD, eating disorders (ED) defined by BE, and BD + BE), and therapeutic implications of BD + BE. Expert opinion: Subphenotyping of complex psychiatric disorders reduces heterogeneity and increases statistical power and effect size; thus, it enhances our capacity to find missing genetic (and other) risk factors. BD + BE has a severe clinical picture and genetic studies suggests a distinct genetic architecture. Differential therapeutic interventions may be needed for patients with BD + BE compared with BD patients without BE. Recognizing the BD + BE subphenotype is an example of moving towards more precise clinical and genetic entities. [ABSTRACT FROM AUTHOR]

Authors' reply to comment by Ciccarese et al. regarding 'Negative SARS-CoV-2 antibodies in patients with positive immunohistochemistry for spike protein in pityriasis rosea-like eruptions' Dear Editor, We thank Ciccarese et al.[1] for their important observations and interest in our article 'Negative SARS-CoV-2 antibodies in patients with positive immunohistochemistry for spike protein in pityriasis rosea-like eruptions', which was published in April 2022.[2] We wish to respond to their observations. A SARS-CoV-2 RNA PCR test was ordered at the initial evaluation, but unfortunately was not performed by the patients (for most patients in Mexico testing represents an important out-of-pocket expense). [Extracted from the article]

A case study of 19-year-old man presented with acute lymphoblastic leukemia was admitted for an allogeneic hematopoietic cell transplant, and mentions that general surgeon performed a minor incision and drainage of the affected area.

Human papillomavirus (HPV) is the most common sexually transmitted disease (STD).[1] Genital HPV infection has been associated with cervical, vulvar and penile neoplasia, and anogenital warts (condylomas).[[2]] Warts are considered benign lesions caused by low-risk HPV genotypes (e.g. HPV 6 or 11) and can usually be distinguished based on clinical inspection.[5] However, clinicians may sometimes be confronted with other skin lesions and dermoscopy can be useful to identify specific dermoscopic patterns for genital warts.[6] This study reports a series of HIV-negative (HIV-) men with typical intrameatal warts and describes the vascular dermoscopic features that aid prompt diagnosis. One patient attended the clinic for an urethral discharge; this was diagnosed as gonorrhoea, and treated with doxycycline 100 mg a day for 10 days, and azithromycin 500 mg a day for 4 days, prior to the cryotherapy for the warts. Noteworthy, seven patients did not have any external lesions, and in only one case, the sexual partner was previously diagnosed with a cervical HPV infection. In our report, all patients were treated with cryotherapy, with efficacy of 100%. [Extracted from the article]

In conclusion, IHQ for SARS-CoV-2 may represent an important tool in the diagnosis of COVID-19 PR-LE especially in patients with negative serology or PCR. Pityriasis rosea-like eruptions (PR-LE) have been recently associated with COVID-19 infection and vaccines. 7 Drago F, Broccolo F, Ciccarese G. Pityriasis rosea, pityriasis rosea-like eruptions, and herpes zoster in the setting of COVID-19 and COVID-19 vaccination. [Extracted from the article]

Abstract: Once dismissed as an innocuous experience of childhood, bullying is now recognized as having significant psychological effects, particularly with chronic exposure. Victims of bullying are at risk for a number of psychiatric disturbances, and growing evidence suggests that the pathophysiological effects of bullying, as with other forms of trauma and chronic stress, create additional health risks.We review the literature on the known sequelae of bullying, including psychiatric and physiological health effects, with a focus on implications for the victim. In addition, since it is now well established that early and chronic exposure to stress has a significant negative impact on health outcomes, we explore the implications of this research in relation to bullying and victimization in childhood. In particular, we examine how aspects of the stress response, via epigenetic, inflammatory, and metabolic mediators, have the capacity to compromise mental and physical health, and to increase the risk of disease. Research on the relevant mechanisms associated with bullying and on potential interventions to decrease morbidity is urgently needed. [ABSTRACT FROM AUTHOR]

Dermoscopy assisting the diagnosis of mycetoma: case report and literature review. Dermoscopy of mycetoma has white structures as the predominant feature, while white scale and yellowish structures were also consistent in our findings with available literature. Currently, descriptions of the dermoscopic features of mycetoma are limited to isolated case reports.3-5 We describe the dermoscopic structures and patterns of patients with actinomycetoma from our mycetoma clinic in northeast Mexico. [Extracted from the article]

Objectives Bipolar disorder ( BD) is a complex disease associated with various hereditary traits, including a higher body mass index ( BMI). In a prior genome-wide association study, we found that BMI modified the association of rs12772424 - a common variant in the gene encoding transcription factor 7-like 2 ( TCF7L2) - with risk for BD. TCF7L2 is a transcription factor in the canonical Wnt pathway, involved in multiple disorders, including diabetes, cancer and psychiatric conditions. Here, using an independent sample, we evaluated 26 TCF7L2 single nucleotide polymorphisms ( SNPs) to explore further the association of BD with the TCF7L2- BMI interaction. Methods Using a sample of 662 BD cases and 616 controls, we conducted SNP-level and gene-level tests to assess the evidence for an association between BD and the interaction of BMI and genetic variation in TCF7L2. We also explored the potential mechanism behind the detected associations using human brain expression quantitative trait loci ( eQTL) analysis. Results The analysis provided independent evidence of an rs12772424- BMI interaction (p = 0.011). Furthermore, while overall there was no evidence for SNP marginal effects on BD, the TCF7L2- BMI interaction was significant at the gene level (p = 0.042), with seven of the 26 SNPs showing SNP- BMI interaction effects with p < 0.05. The strongest evidence of interaction was observed for rs7895307 (p = 0.006). TCF7L2 expression showed a significant enrichment of association with the expression of other genes in the Wnt canonical pathway. Conclusions The current study provides further evidence suggesting that TCF7L2 involvement in BD risk may be regulated by BMI. Detailed, prospective assessment of BMI, comorbidity, and other possible contributing factors is necessary to explain fully the mechanisms underlying this association. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 15-year-old Mexican boy with multiple asymptomatic, slow-growing tumours in the cavum concha and the helix of both ears. Topics discussed include dermoscopy showed nonmelanocytic lesions with arborizing vessels and an absence of punctum; histopathological examination showed a dermal-based cyst lined with epithelium resembling the epidermis; and epidermal cysts appearing as subcutaneous circular nodules with a firm consistency and variable size.

Objectives Brain-derived neurotrophic factor ( BDNF) Val66Met (rs6265) functional polymorphism has been implicated in early-onset bipolar disorder. However, results of studies are inconsistent. We aimed to further explore this association. Methods DNA samples from the Treatment of Early Age Mania ( TEAM) and Mayo Clinic Bipolar Disorder Biobank were investigated for association of rs6265 with early-onset bipolar disorder. Bipolar cases were classified as early onset if the first manic or depressive episode occurred at age ≤19 years (versus adult-onset cases at age >19 years). After quality control, 69 TEAM early-onset bipolar disorder cases, 725 Mayo Clinic bipolar disorder cases (including 189 early-onset cases), and 764 controls were included in the analysis of association, assessed with logistic regression assuming log-additive allele effects. Results Comparison of TEAM cases with controls suggested association of early-onset bipolar disorder with the rs6265 minor allele [odds ratio ( OR) = 1.55, p = 0.04]. Although comparison of early-onset adult bipolar disorder cases from the Mayo Clinic versus controls was not statistically significant, the OR estimate indicated the same direction of effect ( OR = 1.21, p = 0.19). When the early-onset TEAM and Mayo Clinic early-onset adult groups were combined and compared with the control group, the association of the minor allele rs6265 was statistically significant ( OR = 1.30, p = 0.04). Conclusions These preliminary analyses of a relatively small sample with early-onset bipolar disorder are suggestive that functional variation in BDNF is implicated in bipolar disorder risk and may have a more significant role in early-onset expression of the disorder. [ABSTRACT FROM AUTHOR]

Objectives To examine the independent effects of sex on the risk of rapid cycling and other indicators of adverse illness course in patients with bipolar I disorder ( BP-I) or bipolar II disorder ( BP- II). Methods We analyzed data from the first 1,225 patients enrolled in the Mayo Clinic Individualized Medicine Biobank for Bipolar Disorder. Demographic and clinical variables were ascertained using standardized questionnaires; height and weight were assessed to determine body mass index ( BMI). Rates of rapid cycling, cycle acceleration, and increased severity of mood episodes over time were compared between women and men overall and within subgroups defined by bipolar disorder subtype ( BP-I or BP- II). Multiple logistic regression analysis was used to assess the independent effect of sex on the risk of these indicators of adverse illness course. Results Women had significantly higher rates of rapid cycling than men. Overall rates of rapid cycling were higher in patients with BP- II than BP-I; and sex differences in the rate of rapid cycling were more pronounced in patients with BP- II than BP-I, although the power to detect statistically significant differences was reduced due to the lower sample size of subjects with BP- II. Female sex was a significant predictor of rapid cycling, cycle acceleration, and increased severity of mood episodes over time after adjusting for age, bipolar disorder subtype, BMI, having any comorbid psychiatric disorder, and current antidepressant use. Conclusions Female sex was associated with significantly higher risk of rapid cycling, cycle acceleration, and increased severity of mood episodes over time in a sample of 1,225 patients with bipolar disorders. [ABSTRACT FROM AUTHOR]

Objectives To determine whether clinical features of bipolar disorder, such as history of psychosis, and cardiovascular disease ( CVD) risk factors contribute to a higher risk of CVD among patients with bipolar disorder. Methods This cross-sectional study included a sample of 988 patients with bipolar I or bipolar II disorder or schizoaffective bipolar type confirmed by the Structured Clinical Interview for DSM- IV- TR disorders ( SCID). Medical comorbidity burden was quantified utilizing the Cumulative Illness Severity Rating Scale ( CIRS). This 13-item organ-based scale includes cardiac disease severity quantification. Confirmed by medical record review, patients who scored 1 ( current mild or past significant problem) or higher in the cardiac item were compared by logistic regression to patients who scored 0 ( no impairment), adjusting for CVD risk factors that were selected using a backwards stepwise approach or were obtained from the literature. Results In a multivariate model, age [odds ratio ( OR) = 3.03, 95% confidence interval ( CI): 1.66-5.54, p < 0.0001], hypertension ( OR = 2.43, 95% CI: 1.69-3.55, p < 0.0001), and history of psychosis ( OR = 1.48, 95% CI: 1.03-2.13, p = 0.03) were associated with CVD. When CVD risk factors from the literature were added to the analysis, age ( OR = 3.19, 95% CI: 1.67-6.10, p = 0.0005) and hypertension ( OR = 2.46, 95% CI: 1.61-3.76, p < 0.01) remained significant, with psychosis being at the trend level ( OR = 1.43, 95% CI: 0.96-2.13, p = 0.08). Conclusions The phenotype of psychotic bipolar disorder may reflect higher illness severity with associated cardiac comorbidity. Further studies are encouraged to clarify the effect of the disease burden (i.e., depression), lifestyle, and treatment interventions (i.e., atypical antipsychotics) on this risk association. [ABSTRACT FROM AUTHOR]

Low grade evidence showed the number of MPAs in the BD group were significantly higher compared to healthy controls, suggesting an early insult during the neurodevelopment and provides further support to the neurodevelopmental hypothesis of BD. Bipolar disorder, neurobiology, biomarkers, genomics, lithium Keywords: bipolar disorder; neurobiology; biomarkers; genomics; lithium EN bipolar disorder neurobiology biomarkers genomics lithium 1 2 2 08/12/21 20210806 NES 210806 Bipolar disorder (BD) is a severe mental illness, with significant morbidity, and is a leading cause of disability. [Extracted from the article]

Bipolar disorder (BD) is associated with higher body mass index (BMI) and increased metabolic comorbidity. Considering the associated phenotypic traits in genetic studies of complex diseases, either by adjusting for covariates or by investigating interactions between genetic variants and covariates, may help to uncover the missing heritability. However, obesity-related traits have not been incorporated in prior genome-wide analyses of BD as covariates or potential interacting factors. To investigate the genetic factors underlying BD while considering BMI, we conducted genome-wide analyses using data from the Genetic Association Information Network BD study. We analyzed 729 454 genotyped single-nucleotide polymorphism (SNP) markers on 388 European-American BD cases and 1020 healthy controls with available data for maximum BMI. We performed genome-wide association analyses of the genetic effects while accounting for the effect of maximum BMI, and also evaluated SNP-BMI interactions. A joint test of main and interaction effects demonstrated significant evidence of association at the genome-wide level with rs12772424 in an intron of TCF7L2 (P=2.85E−8). This SNP exhibited interaction effects, indicating that the bipolar susceptibility risk of this SNP is dependent on BMI. TCF7L2 codes for the transcription factor TCF/LF, part of the Wnt canonical pathway, and is one of the strongest genetic risk variants for type 2 diabetes (T2D). This is consistent with BD pathophysiology, as the Wnt pathway has crucial implications in neurodevelopment, neurogenesis and neuroplasticity, and is involved in the mechanisms of action of BD and depression treatments. We hypothesize that genetic risk for BD is BMI dependent, possibly related to common genetic risk with T2D. [ABSTRACT FROM AUTHOR]

SARS-CoV-2 spike protein positivity in pityriasis rosea-like and urticaria-like rashes of COVID-19 Dear Editor, The spike protein of SARS-CoV-2 is responsible for receptor recognition and cell membrane fusion.1 Positive immunohistochemistry (IHC) for SARS-CoV/SARS-CoV-2 spike protein has been found in lungs, tracheal mucosa and renal tubular epithelial cells, and recently in chilblain-like and erythema multiforme-like lesions of patients with COVID-19.2 Herein we report on two patients, one with a pityriasis rosea-like rash and one with an urticarial rash, with positive IHC for SARS-CoV/SARS-CoV-2 spike protein. Six weeks earlier he presented COVID-19 infection (confirmed with SARS-CoV-2 reverse-transcriptase polymerase chain reaction); his symptoms included malaise, dysgeusia, anosmia and an urticarial rash. [Extracted from the article]

The article presents a case of a 37-year-old female who was presented with asymptomatic dermatosis affecting the dorsum of her feet and lower legs, was diagnosed with acrodermatitis chronica atrophicans and was treated with doxycycline.

Adiposis dolorosa, or Dercum's disease, is a rare entity of unknown etiology, characterized by the development of painful adipose tissue (lipomas or diffuse adipose tissue) mainly in the limbs or trunk in overweight or obese individuals.1 Different treatment modalities aim to improve symptomatology of this often incapacitating disease; however, current surgical options are limited. Approximately 33% of dermatologists do not use the punch technique to remove lipomas (even solitary 1-cm lesions), most commonly because they are not familiarized with the procedure.3 Recurrence rate of lipomas removed with punch has been reported to be around 1.4%.3 Other treatment modalities include intralesional steroids and deoxycholic acid for extensive disease.4 Limitations to our technique might include larger lipomas and other variants of Dercum's disease with diffuse painful adipose tissue. [Extracted from the article]

Leprosy reactions (LR) are acute inflammatory episodes that manifest as skin lesions, neuritis and systemic symptoms in patients with leprosy infection. Of the LR cases, 65 (89%) corresponded to lepromatous leprosy (LL) and 8 (11%) to borderline lepromatous leprosy (BL). The leprosy type most frequently associated with ENL was lepromatous leprosy in 59 (80.8%). [Extracted from the article]

Suicide is a major public health concern; nevertheless, its neurobiology remains unknown. An area of interest in suicide research is the dorsolateral prefrontal cortex (DLPFC). We aimed to identify altered proteins and potential biological pathways in the DLPFC of individuals who died by suicide employing mass spectrometry-based untargeted proteomics. Postmortem DLPFC from age-matched male suicide mood disorder cases (n = 5) and non-suicide mood disorder cases (n = 5) were compared. The proteins that differed between groups at false discovery rate (FDR) adjusted p-values (Benjamini–Hochberg–Yekutieli) <0.3 and Log2 fold change (FC) >|0.4| were considered statistically significant and were subjected to pathway analysis by Qiagen Ingenuity software. Thirty-three of the 5162 detected proteins showed significantly altered expression levels in the suicide cases and two of them after adjustment for body mass index. The top differentially expressed protein was potassium voltage-gated channel subfamily Q member 3 (KCNQ3) (Log2FC = −0.481, p = 2.10 × 10−09, FDR = 5.93 × 10−06), which also showed a trend to downregulation in Western blot (p = 0.045, Bonferroni adjusted p = 0.090). The most notably enriched pathway was the GABA receptor signaling pathway (p < 0.001). Here, we report a reduction trend of KCNQ3 levels in the DLPFC of male suicide victims with mood disorders. Further studies with a larger sample size and equal sex representation are needed. [ABSTRACT FROM AUTHOR]

The article offers information on a study which highlights that the predominant clinical feature of pityriasis lichenoides chronica (PLC) in dark skinned patients may be hypopigmented macules and patches. It mentions that patients with clinical and histopathological diagnosis consistent with PLC were included. In subjects with clinical suspicion of early mycosis fungoides, immunohistochemical analysis was done to discard this diagnosis.