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Cinnamaldehyde (CNM) is an essential-oil component with reported anti-infective, anti-inflammatory, and healing effects, making it an interesting compound for the treatment of wound infection. Herein, we evaluated the effects of topical administration of CNM in experimental wounds infected by Staphylococcusaureus. Swiss mice (n = 12/group) were randomly allocated into three groups (CON: animals with uninfected lesions; Sa: animals with untreated infected lesions; Sa + CNM: animals with infected wounds and treated with CNM). Excisional lesions (64 mm2) were induced at the dorsal area followed by the addition of S. aureus (80 μL of a 1.5 × 108 CFU/mL bacterial suspension). The wounds were treated with CNM (200 μg/wound/day) or vehicle (2% DMSO) for 10 days. Skin samples were taken on the 3rd or 10th treatment day for quantification of inflammatory mediators, bacterial load, immunophenotyping, and histological analysis. The treatment with CNM improved the healing process and attenuated the severity of skin lesions infected by S. aureus. These effects were associated with significant decreases in bacterial loads in CNM-treated wounds. The levels of neutrophils, TNF-α, IL-6, NO, and VEGF were decreased in the lesions treated with CNM. Taken together, these data provide further evidence of the effectiveness of CNM for the treatment of skin infections.

RESUMEN Se presenta el caso de un paciente varón de 28 años, heterosexual, con VIH negativo que desarrolló erupción cutánea intensa caracterizada por la presencia de vesículas, pústulas y pápulas umbilicadas confluentes en el pene y región púbica con escasa diseminación en el resto del cuerpo, sin adenopatía ni manifestaciones sistémicas, cuatro días después de haber tenido relaciones sexuales con una prostituta aparentemente sana. El hisopado de las lesiones dérmicas revelaron la presencia de ADN del virus MPOX por PCR en tiempo real. Las pruebas inmunológicas fueron las siguientes: ELISA cuarta generación para VIH y Western Blot negativas, anticuerpos IgM para herpes simplex1=1.2 U/ml, anticuerpos IgM para herpes simplex2=1.9 U/ml, anticuerpos IgM para varicela zóster=0.5 S/CO, FTA-ABS (IgM)=negativo. Se resalta la intensidad de las lesiones cutáneas en el pene y la necesidad de realizar pruebas para descarte de MPOX en prostitutas.

Background Ketoconazole, an antifungal agent, adversely affects spermatogenesis in rodents, but knowledge on adverse effects of prolonged administration of ketoconazole on the fertility of male dogs is lacking. A case of reversible infertility with azoospermia in a male American Staffordshire terrier treated with ketoconazole is reported here. Case presentation A seven-year old male American Staffordshire terrier treated for 3 months with ketoconazole for a persistent Malassezia dermatitis displayed reduced libido and mating of 3 bitches had been unsuccessful. The dog was presented at the clinic 40 days after the treatment had been stopped. At first presentation, low libido and complete absence of sperm in the ejaculate (azoospermia) associated with low testosterone level were found. Repeated examinations revealed that sperm quality and testosterone level had restored 100 days after ketoconazole had been withdrawn. Thereafter, the dog successfully mated 2 bitches. Conclusion The treatment with ketoconazole for 3 months may have led to reversible infertility characterized by azoospermia. Therefore, owners of stud dogs should be informed of this risk prior to initiating such treatment and in case of infertility, previous treatment with ketoconazole should be considered as a possible cause.

Discharging facial lesions of dental etiology are almost always difficult to diagnose. Due to the lack of dental signs in most patients, these lesions are often misunderstood and overlooked. Such patients often seek cosmetic therapy and end up undergoing unnecessary treatments, if an odontogenic source is not established. To make an accurate diagnosis, a comprehensive medical and dental history, as well as knowledge of the various presentations of facial lesions, is of pivotal importance. The cases identified here were misdiagnosed at first, and they were treated with antibiotics and surgical procedures as a result. Root canal operations were performed after referral to a dental unit, and the sinus tract eventually healed. This emphasizes the significance of taking odontogenic sources into account when treating head and neck lesions.

This scoping review will examine the impact of the availability of clinical information on the diagnostic accuracy of cutaneous melanoma and the effect on patient outcomes.

Background In recent years, the rate of immunosuppressed patients has increased rapidly. Invasive fungal infections usually occur in these patients, especially those who have had hematological malignances and received chemotherapy. Fusariosis is a rare pathogenic fungus, it can lead to severely invasive Fusarium infections. Along with the increased rate of immune compromised patients, the incidence of invasive Fusarium infections has also increased from the past few years. Early diagnosis and therapy are important to prevent further development to a more aggressive or disseminated infection. Case summary We report a case of a 19-year-old male acute B-lymphocytic leukemia patient with fungal infection in the skin, eyeball, and knee joint during the course of chemotherapy. We performed skin biopsy, microbial cultivation, and molecular biological identification, and the pathogenic fungus was finally confirmed to be Fusarium solani. The patient was treated with oral 200 mg voriconazole twice daily intravenous administration of 100 mg liposomal amphotericin B once daily, and surgical debridement. Granulocyte colony-stimulating factor was administered to expedite neutrophil recovery. The disseminated Fusarium solani infection eventually resolved, and there was no recurrence at the 3 mo follow-up. Conclusion Our case illustrates the early detection and successful intervention of a systemic invasive Fusarium infection. These are important to prevent progression to a more aggressive infection. Disseminate Fusarium infection requires the systemic use of antifungal agents and immunotherapy. Localized infection likely benefits from surgical debridement and the use of topical antifungal agents.

The relatively unknown genus Iodobacter sp. has been repeatedly isolated from skin ulcers and saprolegniosis on freshwater fish in Finland, especially farmed salmonids. Genetic characterization verified that all 23 bacterial isolates studied here belonged to the species Iodobacter limnosediminis, previously undescribed from the fish microbiota. Whole-genome pulsed-field gel electrophoresis revealed variability between the I. limnosediminis strains, suggesting that they were most likely of environmental origin. Two I. limnosediminis strains caused lesions in 27%–53% of brown trout (Salmo trutta) injected intramuscularly (p ≤ .05). The lesions represented moderate to severe tissue damage, but for most fish, the tissues had been repaired by the end of the experiment through the accumulation of fibrocytes and macrophages at the site of the lesion. I. limnosediminis was reisolated from some lesions and/or internal organs. Phenotypically and biochemically, I. limnosediminis resembles several common bacterial species found in the aquatic environment, as it grows well on several media as whitish medium-sized colonies, is Gram negative and rod-shaped. Here, we characterized I. limnosediminis strains with several methods, including MALDI-TOF. This characterization will help in further investigations into the occurrence and possible involvement of I. limnosediminis in skin lesions of freshwater fish. peerReviewed

Today, the rapid development of industrial zones leads to an increased incidence of skin diseases because of polluted air. According to a report by the American Cancer Society, it is estimated that in 2022 there will be about 100,000 people suffering from skin cancer and more than 7600 of these people will not survive. In the context that doctors at provincial hospitals and health facilities are overloaded, doctors at lower levels lack experience, and having a tool to support doctors in the process of diagnosing skin diseases quickly and accurately is essential. Along with the strong development of artificial intelligence technologies, many solutions to support the diagnosis of skin diseases have been researched and developed. In this paper, a combination of one Deep Learning model (DenseNet, InceptionNet, ResNet, etc) with Soft-Attention, which unsupervisedly extract a heat map of main skin lesions. Furthermore, personal information including age and gender are also used. It is worth noting that a new loss function that takes into account the data imbalance is also proposed. Experimental results on data set HAM10000 show that using InceptionResNetV2 with Soft-Attention and the new loss function gives 90 percent accuracy, mean of precision, F1-score, recall, and AUC of 0.81, 0.81, 0.82, and 0.99, respectively. Besides, using MobileNetV3Large combined with Soft-Attention and the new loss function, even though the number of parameters is 11 times less and the number of hidden layers is 4 times less, it achieves an accuracy of 0.86 and 30 times faster diagnosis than InceptionResNetV2.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Skin lesions are considered a public health problem, because in addition to compromising and impairing the quality of life of individuals, they can generate high costs for the health system. In this context, the search for biomaterials that can treat and recover damaged tissues is growing. Studies show that Natural Rubber (NR), extracted from Hevea brasiliensis rubber trees, is a biocompatible biopolymer that has properties that help in the tissue repair process. However, for biomedical applications, it has certain limitations related to the presence of allergenic proteins, hydrophobicity and unsaturated bonds, which limiting its application. In order to overcome these limitations and contribute to the development of new biomaterials, this study aims to deproteinize, epoxidize and graft NR with hyaluronic acid (HA), which is extremely widespread in the medical field due to its bioactive properties. The study also aimed to evaluate the behavior of the new material as a release system for active compounds. For this purpose, the release profile of dry chamomile flower extract (CHAM) was tested due to its therapeutic properties. Therefore, the 1st stage of this work investigated two different methodologies to obtain the proposed material, which were called 1st and 2nd route. Both materials were analyzed by Fourier Transform Infrared Spectroscopy (FTIR), which allowed us to observe signs of deproteinization and esterification grafting between the epoxidized NR and HA molecules. Hydrogen Nuclear Magnetic Resonance Spectroscopy (1H NMR) analysis corroborated the results obtained by FTIR. Thermogravimetry (TG) and Differential Scanning Calorimetry (DSC) thermal analyzes showed that the grafted sample had a lower degradation rate and a higher glass transition temperature (Tg), indicating strong intermolecular interactions. In the 2nd stage, it was found by FTIR that the interaction between the grafted material and CHAM is merely physical. The TG showed that the incorporation of CAM to the modified material is capable of causing a decrease in its thermal stability. The DSC showed that the addition of CHAM can cause a slight increase in the flexibility of the material. Finally, the release profile showed that the grafted material is capable of acting in the CHAM release process, which makes the material promising to be applied in the future in the treatment of skin lesions. As lesões cutâneas são consideradas um problema de saúde pública, pois além de comprometer e prejudicar a qualidade de vida dos indivíduos, podem gerar altos custos ao sistema de saúde. Neste âmbito, é crescente a busca por biomateriais que possam tratar e recuperar tecidos lesionados. Estudos apontam que a Borracha Natural (BN), extraída de seringueiras Hevea brasiliensis, é um biopolímero biocompatível e que possui propriedades que auxiliam no processo de reparo tecidual. No entanto, para aplicações biomédicas, possui certas limitações relacionadas a presença de proteínas alergênicas, hidrofobicidade e ligações insaturadas, que acabam limitando a sua aplicação. A fim de superar tais limitações e contribuir no desenvolvimento de novos biomateriais, este estudo tem por objetivo desproteinizar, epoxidar e graftizar a BN com ácido hialurônico (AH), que é extremamente difundido na área médica devido às suas propriedades bioativas. O estudo também teve por finalidade avaliar o comportamento do novo material como sistema de liberação de compostos ativos. Com esse propósito, foi testado o perfil de liberação do extrato seco de flor de camomila (CAM) devido as suas propriedades terapêuticas. Sendo assim, a 1ª etapa deste trabalho investigou duas metodologias distintas para a obtenção do material proposto, as quais foram denominadas 1ª e 2ª rota. Ambos os materiais obtidos foram analisados por Espectroscopia no Infravermelho com Transformada de Fourier (FTIR), que permitiu observar indícios de desproteinização e graftização por esterificação entre as moléculas de BN epoxidada e AH. A Espectroscopia de Ressonância Magnética Nuclear de Hidrogênio (1H RMN) corroborou com os resultados obtidos por FTIR. As análises térmicas de Termogravimetria (TG) e Calorimetria Exploratória Diferencial (DSC) demonstraram que a amostra graftizada apresentou menor taxa de degradação e um maior valor de temperatura de transição vítrea (Tg), indicando fortes interações intermoleculares. Por outro lado, na 2ª etapa constatou-se por FTIR que a interação entre o material graftizado e CAM é meramente fisica. A TG apontou que a incorporação de CAM ao material modificado é capaz de provocar uma diminuição na estabilidade térmica do mesmo. O DSC mostrou que a adição de CAM pode ocasionando um leve aumento da flexibilidade do material. Por fim, o perfil de liberação mostrou que o material graftizado é capaz de atuar no processo de liberação de CAM, o que torna o material promissor para futuramente ser aplicado no tratamento de lesões cutâneas. 88887.492777/2020-00

Rashes and skin lesions are a common reason for patient visits to emergency departments and physicians’ offices. The differential diagnosis includes a variety of infectious and non-infectious diseases, some of which can be life-threatening. The aim of this retrospective study was to evaluate the quantity and type of skin lesions among outpatients and inpatients at a tertiary care university-affiliated teaching hospital for infectious diseases over a three-year period to assess disease burden and physicians’ experience in diagnosing skin lesions. Diagnoses (by ICD-10 codes) were classified into three groups: infectious diseases that include skin lesions, non-infectious skin lesions and undiagnosed skin lesions. During the observed period, out of the total of 142,416 outpatients, 14.8% presented with some form of skin lesion. Among them, 68% had skin lesions inherent to infectious disease, 10.8% suffered from non-infectious skin lesions and 21.2% remained with undiagnosed skin lesions. The most common infectious diagnoses were chickenpox, herpes zoster and unspecified viral infections characterized by skin and mucous membrane lesions. The most common non-infectious diagnoses were urticaria and atopic dermatitis. Overall, the most common individual diagnosis (ICD-10 code) was “nonspecific skin eruption” (n = 4448, 21.1%), which was followed by chickenpox and herpes zoster. Among the 17,401 patients hospitalized over the observed period, 13.1% had skin lesion as the main reason for hospitalization, almost all (97.5%) of which were infectious in etiology. The most common diagnoses were cellulitis, erysipelas and herpes zoster. The presented data suggest that the burden of diseases presenting with skin lesions is significant in everyday infectious disease practice, but the overwhelming number of undiagnosed patients implies the need for further education in this area.

Skin cancer is one of the most prevalent cancers worldwide. In the advent of medical digitization and telepathology, hyper/multispectral imaging (HMSI) allows for noninvasive, nonionizing tissue evaluation at a macroscopic level.We aim to summarize proposed frameworks and recent trends in HMSI-based classification and segmentation of gross-level skin tissue.A systematic review was performed, targeting HMSI-based systems for the classification and segmentation of skin lesions during gross pathology, including melanoma, pigmented lesions, and bruises. The review adhered to the 2020 Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. For eligible reports published from 2010 to 2020, trends in HMSI acquisition, preprocessing, and analysis were identified.HMSI-based frameworks for skin tissue classification and segmentation vary greatly. Most reports implemented simple image processing or machine learning, due to small training datasets. Methodologies were evaluated on heavily curated datasets, with the majority targeting melanoma detection. The choice of preprocessing scheme influenced the performance of the system. Some form of dimension reduction is commonly applied to avoid redundancies that are inherent in HMSI systems.To use HMSI for tumor margin detection in practice, the focus of system evaluation should shift toward the explainability and robustness of the decision-making process.

Resumen: Introducción: La piel es fundamental en la transición de la vida intrauterina a la extrauterina. El recién nacido presenta cambios fisiológicos, siendo frecuente observar hallazgos cutáneos benignos y transitorios que varían según las características maternas, neonatales y de la gestación. Objetivos: Estimar la frecuencia de distintos hallazgos dermatológicos en neonatos en las primeras 72 h de vida e identificar la existencia de diferencias de proporciones estadísticamente significativas con factores neonatales, maternos y de la gestación. Métodos: Se realizó un estudio descriptivo, observacional de corte transversal entre abril-julio 2015 y julio-noviembre de 2017 en la maternidad del Centro Hospitalario Pereira Rossell. Se incluyeron neonatos de hasta 72 h de vida, a los que se les practicó un examen dermatológico completo. Se presenta la proporción de cada uno de los hallazgos con el intervalo de confianza (IC) correspondiente. Se analiza la relación entre los hallazgos y determinados factores asociados. Resultados: Se incluyeron 2811 neonatos. El 100% presentó al menos un hallazgo a nivel de la piel. La mediana fue de 8 lesiones por paciente (rango intercuartílico: 6-9/mínimo-máximo: 1-16). De los 46 hallazgos explorados clínicamente se encontraron 42. Las lesiones benignas y transitorias correspondieron al 99,9%. Entre ellas se observó: lanugo 98% (IC: 97,7-98,7), descamación fisiológica 79,7% (IC: 78,2-81,1) e hiperplasia sebácea 73,3% (IC: 71,6-74,9). El lanugo (p = 0,001), la descamación fisiológica (p

BACKGROUND Cutaneous lesions of external ear are quite common in clinical practice. Patients often present with various cutaneous lesions of the external ear to various disciplines. They are often underdiagnosed as many lesions, though commonly diagnosed by our dermatologist colleague are missed by other clinicians. These lesions can be classified in various ways, according to the aetiology, and according to the anatomic sites. In the present study, we tried to assess the prevalence of different skin lesions affecting external ear presenting to an ENT and skin outpatient department of a tertiary care medical college in Eastern part of India. METHODS This is a descriptive observational study, cross sectional in design. 240 patients attended the outpatient department with cutaneous lesions affecting external ear from January 2019 to February 2020. The patients presenting in both ENT and skin outpatient department were chosen randomly. Cases were diagnosed based on history and clinical examination and appropriate investigation as required. All cases were categorised into 5 types (infective, inflammatory, autoimmune, neoplasm & naevi, and reactive & reparative) according to the aetiology. In each category, prevalence of various skin lesions was recorded. RESULTS A total number of 240 cases were detected during the study period. Among them, infective 43.33 %, inflammatory 30.83 %, autoimmune 9.17 %, neoplasm & naevi 4.17 % and reactive & reparative were 12.82 %. Taenia was the most common lesions encountered (20.51 %) followed by keloid (12.5 %). Impetigo and seborrheic dermatitis shared same number of cases (9.4 %). Neoplastic lesions were the least common. CONCLUSIONS With some awareness and basic knowledge, many of the cutaneous lesions of external ear can be diagnosed and treated whenever patients report to a clinician, thus saving valuable time, effort and money of the patient. KEYWORDS Cutaneous Lesions, Skin Lesions, External Ear

We investigated the local and systemic effects of hyperbaric oxygen therapy in BALB/C mice, exposed to two different exposure times, under 2.4 atmosphere (ATM). Fifteen animals were divided into three groups (GI, GII and Control) and underwent a surgical excision of a skin fragment of approximately one square centimeter of the dorsal region. The wounds were treated and monitored for 21 days. In the control group, the wound was cleaned once a day with sterile 0.9% NaCl solution. GI and GII mice were submitted to daily hyperbaric oxygen therapy of 30 or 60minutes sessions, respectively. The wounds were photographed every three days and their surfaces were analyzed by an image analyzer. At 21 days, all animals were euthanatized for histopathological analysis of the skin, lungs and liver in order to identify eventual alterations in wound healing or in the analyzed organs. Animals belonging to GI showed a faster skin wound healing in comparison to the other groups. Animals from GII, however, showed a delayed wound healing process and exhibited lung and microcirculatory alterations. These findings allow us to conclude that the exposure time to the oxygen in hyperbaric environment is crucial and can help or disturb skin wound healing or even be deleterious to other organs. RESUMO Investigaram-se os efeitos locais e sistêmicos da oxigenoterapia hiperbárica em camundongos BALB / C, submetidos a dois tempos de exposição diferentes, sob atmosfera 2,4 (ATM). Quinze animais foram divididos em três grupos (GI, GII e controle) e submetidos à excisão cirúrgica de fragmento de pele de aproximadamente um centímetro quadrado da região dorsal. As feridas foram tratadas e acompanhadas por 21 dias. No grupo controle, a ferida foi limpa uma vez ao dia, com solução estéril de NaCl 0,9%. Camundongos GI e GII foram submetidos à oxigenoterapia hiperbárica diária de 30 ou 60 minutos de sessões, respectivamente. As feridas foram fotografadas a cada três dias, e suas superfícies analisadas por um analisador de imagens. Aos 21 dias, todos os animais foram submetidos à eutanásia para análise histopatológica da pele, do pulmão e do fígado, em busca de eventuais alterações na cicatrização da ferida ou nos órgãos analisados. Animais pertencentes ao GI apresentaram cicatrização mais rápida de feridas cutâneas em comparação aos outros grupos. Já os animais do GII apresentaram retardo na cicatrização da ferida e alterações pulmonares e microcirculatórias. Esses achados permitem concluir que o tempo de exposição ao oxigênio em ambiente hiperbárico é fundamental e pode auxiliar ou atrapalhar a cicatrização de feridas cutâneas ou mesmo ser deletério para outros órgãos.

Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated fibroinflammatory condition affecting multiple organs; however, the involvement of skin lesions is rare. We herein report a 65-year-old man who presented with pruritic punctate purpura on both legs and elevated liver enzyme levels. Computed tomography showed enlargement of the pancreas and thickening of the bile duct wall. Magnetic resonance cholangiopancreatography showed diffuse irregular constriction of the main pancreatic duct, stricture of the lower common bile duct, and dilation after confluent stricture. A histopathologic examination of the pancreas and his enlarged salivary gland showed infiltration of IgG4-positive plasma cells. Ultimately, the patient was diagnosed with IgG4-RD.

Background Operation notes often have omissions and are difficult to locate in patients notes despite clear guidance from the Royal College of Surgeons (RCS) 'Good Surgical Practice' 2014 outlining what should be included in operation notes. Procedure-specific proformas are rarely used by Plastic surgeons despite being utilised by other specialities. With an alarming rise of incidence of skin malignancies there has been an increase in the number of skin lesions referred to Plastic surgeons for excision. The need for reliable, reproducible, accurate and easily accessible operating notes for skin lesion excision is pivotal for continuity of care and treatment planning. This study aimed at comparing the quality of skin lesion operation notes prior-to and after implementation of a procedure-specific proforma in relation to RCS recommendations. Methods Fourteen parameters from the recommendations by the RCS ‘Good Surgical Practice’ 2014 guidelines were used to audit skin lesion operation notes. The study consisted of a retrospective audit of 80 operation notes and a prospective audit of 80 operation notes following the development and implementation of a skin lesion procedure-specific proforma. We assessed and compared the operation notes overall compliance with the RCS guidelines. Statistical analysis highlighting the difference between both groups was performed using the independent sample t-test. Results After implementation of the skin lesion procedure-specific proforma, the average compliance with the RCS recommendations increased significantly from 87.5% retrospectively to 98.8% prospectively (p-value 0.0414). In 6 of the 14 parameters assessed significant improvements with regards compliance to the guidelines was demonstrated. Conclusion The development and implementation of a skin lesion procedure-specific proforma has demonstrated a significant improvement in the quality of operation notes within a Plastic surgery department which has the potential to minimise omissions and improve continuity of surgical patient care.

Owing to their similarities, pigs are often used as experimental models for humans. In particular, the similarity of the skin allows them to be a good dermatological model. The aim of the study was to develop an animal model in conventional domestic pigs to evaluate skin lesions macroscopically and histologically after a continuous subcutaneous apomorphine application. A total of 16 pigs from two different age groups were injected with four different apomorphine formulations for 12 h daily over a period of 28 days into the subcutis, which was then evaluated macroscopically for nodules and erythema, as well as histologically. Differences in skin lesions between the formulations were found, with formulation 1 leading to the fewest nodules, least skin lesions, no lymph follicles, least necrosis, and best skin tolerance. Older pigs were easier to handle and, because of the thicker skin and subcutis of these animals, drug application with the appropriate needle length was safer. The experimental setup worked well and an animal model to assess skin lesions after a continuous subcutaneous application of drugs could be successfully established.

Background and Aim: Zinc has a wide spectrum of biological activities and its deficiency has been related to various dysfunctions. This study aimed to clarify the clinical, hematological, and biochemical changes in Holstein dairy calves with naturally occurring hypozincemia before and after treatment. Materials and Methods: This study was carried out on 25 Holstein dairy calves

En este artículo de opinión comentaremos que la NANDA-I viene trabajando desde el año 2002 en clasificar los niveles de evidencia (teoría de la validez) de los diagnósticos enfermeros. De este modo pretende reflejar el estado de la práctica basada en la evidencia (PBE) en asociación con la taxonomía del lenguaje enfermero estandarizado. La estructura jerárquica de niveles de evidencia que sigue la NANDA-I se organiza en tres niveles principales (nivel 1, nivel 2 y nivel 3) que representa el estado de desarrollo teórico-clínico y la fortaleza de la evidencia disponible; y a su vez, cada nivel se compone de varios subniveles que representan el método de estudio. Sin embargo, el Comité de Desarrollo Diagnóstico de NANDA-I, ya está trabajando desde el 2021 en una nueva clasificación que rebaja los niveles de evidencia a 2 tipos, pero incluye indicadores clínicos y criterios de mayor calidad ampliando los subniveles. Se espera que la nueva escala de evidencia será implementada en próximas ediciones. [Levels of evidence of the NANDA-I diagnoses related to skin lesions] In this opinion article we will comment that NANDA-I has been working since 2002 to classify the levels of evidence (validity theory) of nursing diagnoses. In this way, it aims to reflect the state of evidence-based practice (EBP) in association with the standardized nursing language taxonomy. The hierarchical structure of levels of evidence followed by NANDA-I is organized into three main levels (level 1, level 2 and level 3) representing the state of theoretical-clinical development and the strength of the available evidence; and in turn, each level is composed of several sublevels representing the method of study. However, the NANDA-I Diagnostic Development Committee is already working since 2021 on a new classification that lowers the levels of evidence to 2 types, but includes clinical indicators and criteria of higher quality by expanding the sublevels. It is expected that the new evidence scale will be implemented in future editions.

Objectives The face aging processes are associated with physiologic and biochemical alteration that produces wrinkles, skin pigmentation and benign growths. The aim of this study was to evaluate the clinical efficacy of voltaic arc dermabrasion with plasma to remove benign facial skin lesions. Study Design Voltaic arc dermabrasion plasma technique was used to remove the facial benign skin lesions. The study involved 45 patients (26 females;19 males) treated for benign facial skin lesions with voltaic arc dermabrasion also called plasma exeresis technique. The subjects age ranged between 43 and 65 years. The clinical observations and comparison of pretreatment and post-treatment photographs of the treated regions were performed by a joint examiner at each follow-up visit. Results During plasma irradiation, the average temperature of the skin was 290.3 ± 21.7 °C, while immediately after it was 90.6 ± 21.8 °C. Overall clinical improvement was 100% in six lesions with complete resolution of all lesions. Three patients observed a transient post-inflammatory pigmentation with a peak at 1 month after VAD treatment, gradually fading spontaneously over 2 to 3 months. Conclusions The voltaic arc dermabrasion technique (atmospheric plasma) should be considered for lesions, especially relatively superficial ones, and small lesions that are located on the face. Level of Evidence IV 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.

Background and objective: Automatic semantic segmentation of skin lesions is one of the most important medical requirements in the diagnosis and treatment of skin cancer, and scientists always try to achieve more accurate lesion segmentation systems. Developing an accurate model for lesion segmentation helps in timely diagnosis and appropriate treatment. Methods: In this study, a two-stage deep learning-based method is presented for accurate segmentation of skin lesions. At the first stage, detection stage, an approximate location of the lesion in a dermoscopy is estimated using deep Yolo v2 network. A sub-image is cropped from the input dermoscopy by considering a margin around the estimated lesion bounding box and then resized to a predetermined normal size. DeepLab convolutional neural network is used at the second stage, segmentation stage, to extract the exact lesion area from the normalized image. Results: A standard and well-known dataset of dermoscopic images, (ISBI) 2017 dataset, is used to evaluate the proposed method and compare it with the state-of-the-art methods. Our method achieved Jaccard value of 79.05%, which is 2.55% higher than the Jaccard of the winner of the ISIC 2017 challenge. Conclusion: Experiments demonstrated that the proposed two-stage CNN-based lesion segmentation method outperformed other state-of-the-art methods on the well-known ISIB2017 dataset. High accuracy in detection stage is of most important. Using the detection stage based on Yolov2 before segmentation stage, DeepLab3+ structure with appropriate backbone network, data augmentation, and additional modes of input images are the main reasons of the significant improvement.

Introduction Our previous clinical studies have demonstrated the short-term efficacy and safety of the sirolimus gel for patients with tuberous sclerosis complex (TSC). However, long-term clinical evidence is lacking. Our objective was to assess the safety and efficacy of long-term treatment with the sirolimus gel for the skin lesions of TSC patients. Methods We conducted a multicenter, open-label, uncontrolled clinical trial in 94 Japanese patients with TSC. Patients applied the 0.2% sirolimus gel on their face or head twice daily for > 52 weeks (maximum 136 weeks for safety). The safety endpoints were the rate of adverse event (AE)-caused discontinuation (primary endpoint) and the incidence of AEs. The efficacy endpoint was the response rate of angiofibromas, cephalic plaques, and hypomelanotic macules. Results Among 94 enrolled patients (mean age, 21 years; range 3–53 years), the rate of AE-caused discontinuation was 2.1% (2/94 patients). Although application site irritation and dry skin occurred relatively frequently, none of the drug-related AEs were serious; most of the drug-related AEs resolved rapidly. The major drug-related AEs (≥ 5% in incidence) were application site irritation (30.9%), dry skin (27.7%), acne (20.2%), eye irritation (8.5%), pruritus (8.5%), erythema (7.4%), dermatitis acneiform (6.4%), and dermatitis contact (5.3%). The response rates of angiofibromas, cephalic plaques, and hypomelanotic macules were 78.2% [95% confidence interval (CI) 68.0–86.3%], 66.7% (95% CI 51.1–80.0%), and 72.2% (95% CI 46.5–90.3%), respectively. Conclusions The gel was well tolerated for a long time by patients with TSC involving facial skin lesions and continued to be effective. Trial Registration ClinicalTrials.gov identifier: NCT02634931.

We propose a new method for the analysis and classification of HSI images. The method uses deep learning to interpret the molecular vibrational behaviour of healthy and tumoral human epithelial tissue, based on data gathered via SWIR (short-wave infrared) spectroscopy. We analyzed samples of Melanoma, Dysplastic Nevus and healthy skin. Preliminary results show that human epithelial tissue is sensitive to SWIR to the point of making possible the differentiation between healthy and tumor tissues. We conclude that HSI-SWIR can be used to build new methods for tumor classification.

Introduction: The first cases of coronavirus disease 2019 (COVID-19) were noted in December 2019 in Wuhan province, China The World Health Organisation (WHO) announced the pandemic status on March 11, 2020 The manifestations of the disease are as follows: fever, cough, fatigue, anosmia and ageusia, dyspnoea, chest pain, muscle soreness, chills, sore throat, rhinitis, headache, gastrointestinal (GI) symptoms, and dermal lesions Aim: To evaluate the relationship between dermal lesions and GI symptoms in a group of COVID-19 patients Material and methods: A group of 441 COVID-19 patients admitted to the Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw between March 15th and June 15th, 2020 Results: Of 441 patients with confirmed SARS-CoV-2 infection, 255 (58 5%) experienced gastrointestinal (GI) symptoms: lack of appetite was reported in 124 (48 6%) cases, diarrhoea was noted in 109 (42 7%), abdominal pain in 95 (37 3%), vomiting in 37 (14 5%), and nausea in 32 (12 5%) cases Eight (1 81%) patients had dermal lesions: erythematous macular lesions (2 patients - 25%), erythematous infiltrated lesions (2;25%), erythematous infiltrated and exfoliative lesions (3;37 5%), erythematous papular lesions (3;37 5%), and erythematous oedematous lesions (2;25%) All of those patients reported gastrointestinal symptoms during the hospitalisation Conclusions: The following study analyses possible causes of dermal lesions and their coexistence with GI symptoms Several possible theories were taken into account, including the microbiota alterations and issue of drug-related complications © 2020 Termedia Publishing House Ltd All rights reserved

Context: Hidradenitis suppurativa is a noncontagious, inflammatory, chronic and recurrent disease. The prevalence of HS is estimated to be between less than 1 and 4%. It is more common in females than males at a 2:1 ratio. Many cases of HS are either misdiagnosed or remain undiagnosed. Aims: To assess knowledge of diagnosing hidradenitis suppurativa by Ministry of Health primary health care physicians in Jeddah city, 2019 and to identify the determinants and knowledge of diagnosing hidradenitis suppurativa. Settings and Design: An analytical cross-sectional study conducted in Jeddah city, 2019, among primary health care physicians of the MOH. Methods and Material: Estimated sample size was 114. The required primary health care centers were 38 centers. The centers were chosen by a simple random sampling technique. A reliable self-administered questionnaire was used. Ethical approval was obtained. Statistical Analysis Used: Descriptive statistics consisted of means, standard deviations, frequency tables, cross tabulation and charts). Categorical variables were compared using the chi–square test to determine significant relationships between variables. Results: 65.4% (68) diagnosed the disease correctly. Most of their knowledge came from clinical practice (39.4%). There was a significant relationship with current job title and medical degree (P-value < 0.0005). Conclusion: The present study showed good knowledge about and ability to diagnose HS. A more advanced medical degree and more years of clinical experience was positively associated with the ability to diagnose HS.

Melanoma is a type of skin cancer with a high mortality rate. The different types of skin lesions result in an inaccurate diagnosis due to their high similarity. Accurate classification of the skin lesions in their early stages enables dermatologists to treat the patients and save their lives. This paper proposes a model for a highly accurate classification of skin lesions. The proposed model utilized the transfer learning and pre-trained model with GoogleNet. The model parameters are used as initial values, and then these parameters will be modified through training. The latest well-known public challenge dataset, ISIC 2019, is used to test the ability of the proposed model to classify different kinds of skin lesions. The proposed model successfully classified the eight different classes of skin lesions, namely, melanoma, melanocytic nevus, basal cell carcinoma, actinic keratosis, benign keratosis, dermatofibroma, vascular lesion, and Squamous cell carcinoma. The achieved classification accuracy, sensitivity, specificity, and precision percentages are 94.92%, 79.8%, 97%, and 80.36%, respectively. The proposed model can detect images that do not belong to any one of the eight classes where these images are classified as unknown images.

International audience; Background and aims - Optimal management of patients with inflammatory bowel disease [IBD] after anti-tumour necrosis factor [TNF] discontinuation due to severe induced skin lesions is unclear. Our study aimed to describe dermatological and IBD evolution after anti-TNF discontinuation for this side effect. Methods - We conducted a multicentre retrospective study including consecutive IBD patients who discontinued anti-TNF due to severe induced skin lesions. Our objectives were to determine factors associated with dermatological remission [complete disappearance of skin lesions] and with IBD relapse in patients with inactive disease at inclusion, notably the impact of an early switch to another biological agent within 3 months of anti-TNF discontinuation. Results - Among the 181 patients [134 women, 160 Crohn's disease] included in the 13 participating centres, dermatological remission occurred in 110 [62%] patients with a median [interquartile range, IQR] interval of 8.0 [6.8-11.0] months. Scalp location was independently associated with less remission of skin lesions (hazard ratio [HR] = 0.64 [95% CI 0.43-0.94], p = 0.02) while early switch was independently associated with a higher probability of remission of skin lesions (HR = 1.64 [95% CI 1.1-2.5], p = 0.02). Among the 148 patients with inactive IBD at inclusion, disease relapse occurred in 75 [51%] patients with a median [IQR] interval of 26.0 [23.0-39.1] months. Survival rates without IBD relapse at 1 year were 85.8% [95% CI 77.5-94.9] in the early switch group and 59.3% [95% CI 48.9-71.9] in the other group [p

This study aimed to identify nurses' perception of skin lesions developed in a pediatric hospital in Salvador Bahia. Method: This is a qualitative research, and, in the data collection, we used the interview with a previously prepared script and the discourse analysis to systematize the material obtained. Results: the data show that nurses have mastery of techniques for injury prevention and highlight the importance of continuing education in health care. Conclusion: The peculiarities of the professionals interviewed make it possible to identify individuals who graduated for more than 2 years, 90% female and 70% aged between 31 and 40 years. Through the speeches, the importance of EFA in such injuries was observed, with the main objective of nutrition and hydration of the wound, corroborating the findings in the literature. support in decision making. It was noticed the need for continuing education mainly due to the constant changes in health, an effective skin commission to support and guide these lesions and it was observed through the speeches that the absence of materials can harm the continuity of treatment. Este estudio tuvo como objetivo identificar la percepción de las enfermeras sobre las lesiones cutáneas desarrolladas en un hospital pediátrico de Salvador Bahía. Método: Se trata de una investigación cualitativa, y en la recolección de datos se utilizó la entrevista con guión previamente elaborado y el análisis del discurso para sistematizar el material obtenido. Resultados: los datos muestran que los enfermeros tienen dominio de las técnicas para la prevención de lesiones y destacan la importancia de la educación continua en el cuidado de la salud. Conclusión: Las peculiaridades de los profesionales entrevistados permiten identificar individuos con más de 2 años de formación, el 90% del sexo femenino y el 70% con edades entre 31 y 40 años. A través de las charlas se observó la importancia de los AGE en este tipo de lesiones, teniendo como principal objetivo la nutrición e hidratación de la herida, corroborando lo encontrado en la literatura apoyo en la toma de decisiones Se percibió la necesidad de educación continua principalmente por la constante cambios en la salud, una comisión de piel eficaz para apoyar y orientar estas lesiones y se observó a través de los discursos que la ausencia de materiales puede perjudicar la continuidad del tratamiento. Este estudo objetivou identificar a percepção dos enfermeiros acerca de lesões de pele desenvolvidas em um Hospital pediátrico de Salvador Bahia. Método: Trata-se de pesquisa qualitativa, sendo que, na coleta de dados, recorreu-se à entrevista com roteiro previamente elaborado e à análise de discurso para sistematizar o material obtido. Resultados: os dados evidenciam que os enfermeiros têm domínio acerca das técnicas para prevenção de lesões e destacam a importância da educação continuada no cuidado a saúde. Conclusão: As peculiaridades dos profissionais entrevista­dos permitem identificar indivíduos gradu­ados há mais de 2 anos, 90% do sexo feminino e 70% com idade entre 31 a 40 anos. Através das falas observou-se a importância do AGE em tais lesões, com o objetivo principal de nutrição e hidratação da ferida, corroborando com os achados na literatura., observa-se a inquietude dos profissionais na busca por uma comissão, um núcleo que pudesse dar suporte na tomada de decisões. Percebeu-se a necessidade de uma educação continuada principalmente pelas mudanças constantes na saúde, uma comissão de pele efetiva para dar suporte e orientação sobre essas lesões e observou-se através das falas que a ausência de materiais pode prejudicar na continuidade do tratamento.

The computer-aided diagnosis (CAD) and the analysis of skin lesions using deep learning models have become common in the last decade. The proposed CAD systems have considered various datasets and deep learning models. The transfer of knowledge from particular pre-trained models to others has also gained importance due to the efficient convergence and superior results. This study presents the design and implementation of a transfer learning model using Convolutional Neural Networks (CNN) with variable training epoch numbers to classify skin lesion images obtained by smartphones. The model is divided into the inner and external CNN models to train and transfer the knowledge, and the preprocessing and data augmentation are not applied. Several experiments are performed to classify cancerous and non-cancerous skin lesions and all skin lesion types provided in the dataset separately. The designed model increased the classification rates by 20% compared to the conventional CNN. The transfer learning model achieved 0.81, 0.88, and 0.86 mean recall, mean specificity, and mean accuracy in detecting cancerous lesions, and 0.83, 0.90, and 0.86 macro recall, macro precision, and macro F1 score in classifying six skin lesions. The obtained results show the efficacy of transfer learning in skin lesion diagnosis.

Erysipelas is a zoonotic disease caused by Erysipelothrix rhusiopathiae. In cetaceans, this disease has two main clinical forms: a cutaneous one, grossly characterized by rhomboid lesions, and a septicemic and often fatal form. Erysipelas is considered an important cause of morbidity and mortality in captive cetaceans; however, information in free-ranging cetaceans is limited. An adult common bottlenose dolphin (Tursiops truncatus) was found dead and in advanced autolysis in Paraíba state, northeastern Brazil, on July 19th, 2020. Upon gross examination, 80% of the body surface presented disseminated rhomboid cutaneous lesions ranging from 4 to 6 cm-width, characterized by well-defined edges and occasional ulceration, consistent with erysipelas. Additionally, anthropic-made postmortem linear cuts and partial mechanical removal of the flank musculature were noted. Skin samples were collected for histopathologic and molecular analyses. Microscopically, it was possible to observe multifocal dermatitis with vasculitis. Erysipelothrix sp. was detected by PCR. Despite previous reports of human consumption of cetacean meat in northeastern Brazil, the observed marks and advanced carcass autolysis suggested that the animal was most likely used as bait for fishing instead of human intake. This case highlights the value of postmortem examination and PCR even in poorly preserved cadavers and contributes to the understanding of the epidemiology of cutaneous erysipelas in free-ranging cetaceans (first report in an odontocete from the Southern Hemisphere). Due to the zoonotic potential of certain Erysipelothrix species (i.e., E. rhusiopathiae), active public health policies are required to inform field professionals and the general public about the health threats associated with marine mammal manipulation and consumption.

A erisipela suína é uma doença de distribuição mundial, responsável por causar prejuízos econômicos na suinocultura, além de ser uma doença zoonótica com caráter ocupacional. Estima-se que 30%-50% dos suínos sejam portadores e fatores estressantes podem predispor o aparecimento da doença clínica. O diagnóstico de erisipela em suínos de abate torna-se um desafio aos patologistas, uma vez que os processos de escaldagem e depila, rotineiros em abatedouros frigoríficos, geram artefatos histológicos que muitas vezes impossibilitam o diagnóstico final. Este trabalho descreve os aspectos anatomopatológicos e avalia o uso da imuno-histoquímica como uma ferramenta diagnóstica nestes casos. Foram analisados fragmentos de pele de 43 casos de erisipela em suínos de abate. Macroscopicamente, eram múltiplas lesões cutâneas romboides, retangulares ou quadradas rosa, vermelho ou roxo característicos (“pele de diamante”). Histologicamente, na derme e subcutâneo, havia vasculite, hidradenite e foliculite supurativas, bem como degeneração e necrose da parede de vasos, trombose e áreas de necrose multifocais. A vasculite supurativa e a lesão na parede de vasos sanguíneos foram observadas em todos os casos, em diferentes graus de severidade. A técnica imuno-histoquímica se mostrou um eficaz método complementar de diagnóstico, com imunomarcação positiva em 93%. Na maior parte dos casos observamos marcação discreta (57,5%), moderada em 22,5% e acentuada em 20%. Swine erysipelas is a disease of worldwide distribution, responsible for causing economic losses in swine and considered an occupational zoonotic disease. It is estimated that 30% to 50% of pigs are carriers and stress can predispose the appearance of clinical disease. The diagnosis of erysipelas in slaughter pigs becomes a challenge for pathologists, since scalding and dehairing, routine procedures in slaughterhouses, generate histological artifacts that often make the final diagnosis impossible. This study describes the anatomopathological aspects and evaluate the use of immunohistochemistry as a diagnostic tool in these cases. Forty-three cases of erysipelas in slaughter pigs were analyzed. Grossly, the cutaneous lesions were characteristic pink, red, or purple raised rhomboid, rectangular or square lesions (“diamond skin”). Histologically, in the dermis and subcutaneous tissue, there were suppurative vasculitis, hidradenitis and folliculitis, as well as degeneration and necrosis of the vessel wall, thrombosis and multifocal areas of necrosis. Suppurative vasculitis and damage to the blood vessel wall were observed in all cases, with varying degrees of severity. The immunohistochemical technique proved to be an effective complementary method of diagnosis, with positive immunostaining in 93%. In most cases, we observed mild immunostaining (57.5%), moderate in 22.5% and marked in 20%.

Swine erysipelas is a disease of worldwide distribution, responsible for causing economic losses in swine and considered an occupational zoonotic disease. It is estimated that 30% to 50% of pigs are carriers and stress can predispose the appearance of clinical disease. The diagnosis of erysipelas in slaughter pigs becomes a challenge for pathologists, since scalding and dehairing, routine procedures in slaughterhouses, generate histological artifacts that often make the final diagnosis impossible. This study describes the anatomopathological aspects and evaluate the use of immunohistochemistry as a diagnostic tool in these cases. Forty-three cases of erysipelas in slaughter pigs were analyzed. Grossly, the cutaneous lesions were characteristic pink, red, or purple raised rhomboid, rectangular or square lesions (“diamond skin”). Histologically, in the dermis and subcutaneous tissue, there were suppurative vasculitis, hidradenitis and folliculitis, as well as degeneration and necrosis of the vessel wall, thrombosis and multifocal areas of necrosis. Suppurative vasculitis and damage to the blood vessel wall were observed in all cases, with varying degrees of severity. The immunohistochemical technique proved to be an effective complementary method of diagnosis, with positive immunostaining in 93%. In most cases, we observed mild immunostaining (57.5%), moderate in 22.5% and marked in 20%.

While SARS-CoV-2 is known to cause pneumonia and acute respiratory distress syndrome (ARDS), many extrapulmonary manifesta- tions of COVID-19 have also been observed. Cutaneous manifestations including erythematous rash, urticaria, and chickenpox-like vesicles have been described in patients with SARS-CoV-2. Six patients, two men and four women, in the age group of 50 to 60 years old, hospitalized with SARS-CoV-2 infection confirmed with real-time polymerase chain reac- tion (real-time PCR) presented cutaneous manifestations. The rash was confluent, spotty, centrifugal, and non-itchy on the head and torso. It was not hemorrhagic, and no crust or blisters were observed. The results of laboratory tests were normal, and the rash disappeared on its own. Sev- eral cases of cutaneous manifestations have been reported in patients with SARS-CoV-2 infection. Further studies are needed in order to assess the skin lesions and determine their association with COVID-19.

The burrowing mite Sarcoptes scabiei causes sarcoptic mange in dogs and other mammals, including humans. Despite S. scabiei infests several animals, little is known about the epidemiology, clinical features, and treatment of sarcoptic mange in cats. A few reports have shown that clinical signs of S. scabiei infestation in cats may vary from non-pruritic crusted lesions to itchy and mild lesions, while severe signs are very infrequent. The present report describes a severe case of S. scabiei infestation in a stray cat from Italy, characterized by bilateral alopecia, diffuse and multifocal hyperpigmented, crusted, erythematous, scaled, and exfoliated lesions. The cat was FIV-positive and also infected by the cestode Dipylidium caninum. After treatment with a broad-spectrum parasiticide and an antibiotic, the cat showed an almost complete clinical recovery in 4 weeks. Unfortunately, no further clinical examinations were performed due to the lack of compliance of the owner and to the death of the cat for causes unrelated to sarcoptic mange. This clinical case indicates that under certain circumstances, S. scabiei can reproduce and cause severe clinical signs in cats which are usually considered non-permissive hosts for this mite, and in which the disease is usually self-limiting. Clinic–pathological, epidemiological, and zoonotic implications are discussed.

El presente artículo pretende desarrollar una propuesta marco sobre una asignatura sobre el cuidado de las personas con lesiones cutáneas en el grado de enfermería. Esta ha sido realizada por consenso de expertos, profesores con experiencia en el cuidado de heridas y fue sometida a modificaciones en el marco del Segundo Encuentro Iberolatinoamericano de Facultades y Escuelas Universitarias con Programas Formativos en Heridas. Con ello se presenta una propuesta de competencias sobre el cuidado de las personas con lesiones cutáneas para la enfermera graduada, así como la propuesta curricular, con su estructura pedagógica basada en unidades didácticas y la propuesta de carga docente y ubicación de la asignatura de cuidados de las personas con lesiones cutáneas en el grado en enfermería. Finalmente se presentan documentos de apoyo al profesorado y estudiantado para la creación de la asignatura de cuidados de las personas con lesiones cutáneas para el grado en enfermería. This article aims to develop a framework proposal for a course on the care of people with skin lesions in the nursing degree. It has been developed by consensus of experts, professors with experience in wound care and was subject to modifications in the framework of the Segundo Encuentro Iberolatinoamericano de Facultades y Escuelas Universitarias con Programas Formativos en Heridas. This includes a proposal of competencies on the care of people with skin lesions for the graduate nurse, as well as the Curricular proposal, with its pedagogical structure based on didactic units and the proposed teaching load and location of the subject of care for people with skin lesions in the nursing degree. Finally, support documents are presented for the teaching staff and students for the creation of the subject of care of people with skin lesions for the degree in nursing.

Sweet syndrome, also known as Acute Febrile Neutrophilic Dermatosis, is a rare inflammatory condition. The exact pathogenesis of Sweet syndrome is unclear, however, autoimmune and inflammatory conditions including inflammatory bowel disease have been linked as underlying etiologies. Since its description, in 1964, there have been published less than fifty reports of Crohn’s-associated Sweet syndrome. We report a 43-year-old male patient with a medical history of Crohn’s disease who subsequently developed Sweet syndrome. Two years after the diagnosis of Crohn’s disease the patient was administered a combo therapy with Infliximab and Azathioprine followed by deep remission. A few months later the patient manifested with skin lesions with histopathological findings suggestive of Sweet syndrome. Sweet syndrome, although rare, may occur as an extra-intestinal manifestation of Crohn’s disease. This report illustrates the need for a thorough investigation of patients with Crohn’s disease presenting with skin lesions. We hope it will add to the current literature and help understand this rare phenomenon in order to achieve a proper diagnosis.

A female newborn, born at 38 weeks from an uncomplicated pregnancy in a healthy 36-years-old mother, presented at birth with desquamative erythematous plaques with irregular borders, distributed bilaterally in the orbital, nasal and malar regions. Although there was no history of maternal autoimmune disease, neonatal lupus (NL) was suspected. Maternal and newborn screenings were positive for Sjögren syndrome type A antigen (anti-Ro/SSA) antibodies. No other alterations of NL were found in the newborn. Rheumatologic consultation on the mother showed no other alterations besides the antibodies. The newborn was discharged on day 3 of life without treatment and recommendations to avoid sun exposure. Outpatient follow-up was ensured in neonatology, dermatology and pediatric cardiology. The rash resolved during the first year of life, leaving slight local skin atrophy. NL is a rare transferred autoimmune disease with an incidence estimated as 1:20,000 live births. It occurs due to placental transfer of maternal autoantibodies. The major manifestations are cardiac and cutaneous, but hepatic, hematologic or neurologic findings may also be present. The rash usually affects the face and scalp and may be present at delivery but more often develops later, after exposure to ultraviolet light. It usually resolves within the first year of life without sequelae. NL is the leading cause of congenital heart block, but if it is not present at birth it rarely develops. Some mothers do not have a known autoimmune disease at the time of birth but may develop it later in life. Despite NL being a passively acquired autoimmune disease, the child is at increased risk of rheumatologic disease in childhood or adolescence.

The finding of a pigmented lesion within another distinct lesion is rare but not unheard of. Here, we describe the presence of an atypical fibroxanthoma within a melanoma in a 72-year-old female referred to the plastics surgery department with a pigmented lesion on her left knee. It was excised in view of clinical suspicion of melanoma. The histopathology report documented a single lesion with two distinct components, namely a melanoma of superficial spreading type with a Breslow thickness of 3.0mm, and a central nodule of atypical fibroxanthoma.

Pilomatricomas are rare skin tumors related to hair follicles. They typically present in children, and the most common locations are head and neck. Pilomatricomas are usually painless; however, they can cause cosmetic problems. Treatment is decided on an individual basis and involves local excision. However, caution should be taken if the lesion is malignant, as resection with safe margins (0.5-1.0 cm) is determinant of the overall outcome. Radiotherapy is indicated in cases of residual tumor tissue or recurrence. The role of chemotherapy in pilomatricomas is still undetermined. We report a 55-year-old female with multiple lumps on her shoulder and back. The sonographic features of these lesions were typically consistent with pilomatricomas. The patient decided to opt for excision due to cosmetic reasons and the histopathology features were suggestive of pilomatricoma.

The welfare of male fattening pigs may be improved by refraining from castration, but may be compromised, in turn, by harmful social behaviour in groups of boars. In addition, boar taint may be problematic. This study aimed to evaluate these potential problems in boar fattening under commercial organic conditions. In total, 625 boars were compared with 433 barrows and 83 gilts regarding their social behaviour, lesions and lameness at 80 kg, before and after split marketing. The mixed-model analysis showed that significantly more short agonistic interactions, fights and mounting behaviours were observed in groups of boars. Agonistic interactions were reduced in spring/summer and when boars grew older. Fights and mounts were increased when boars had contact to female pigs in the neighbouring pen. No effect of split marketing, growth rate, homogeneity of groups, group size, feeding space and illumination hours could be detected. Increased interaction frequencies did not result in significantly more skin lesions, lameness, treatments or mortality. Increased space allowance reduced skin lesions. On 9.8% of the dissected boars’ penises, wounds were detected, they were absent on two farms with generous litter provision. Boar taint prevalence, as detected by human nose method, was 1.44%. Under the studied organic husbandry conditions, boar fattening appears to be practicable, although penile injuries should be monitored at slaughter.

OBJECTIVES The purpose of this cross-sectional study was to prepare a reliable and easy-to-use architectural classification for vulvar lichen sclerosus (VLS) aimed at defining the morphological patterns of this condition. MATERIALS AND METHODS An expert panel composed by 7 physicians with expertise in clinical care of vulvar conditions outlined the architectural criteria for the definition of VLS severity (phimosis of the clitoris, involvement of the interlabial sulci, narrowing of the vulvar introitus), identifying 5 grades to build up a classification. Thirteen physicians with 2-30 years expertise in vulvar diseases (nonexpert group) were asked to evaluate 3-5 pictures from 137 patients. Each physician individually assigned a grade to each case, according to the previously mentioned criteria. Interrater reliability was analyzed by means of intraclass correlation coefficient (ICC). The reliability concerning the 2 classifications of each rater was analyzed by means of κ statistic. Intraobserver and interobserver reliability in vivo was analyzed by means of κ index. RESULTS This study provides a new classification of VLS, based on defined anatomical criteria and graded into mutually exclusive progressive classes.The ICC analysis showed a substantial interrater reliability of the classification, ICC = 0.89 (0.87-0.91), both in the expert panel and in the nonexpert group (ICC = 0.92 and 0.87, respectively). An "almost perfect" intraobserver and interobserver reliability was achieved among physicians in vivo (κ = 0.93). CONCLUSIONS Our classification showed a high reliability. It is easy to use, and it can be applied in clinical practice and eventually, in the evaluation of regenerative and cosmetic surgery.

Producción Científica, Coronavirus disease 2019 (COVID-19) is a multisystem disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), that primarily causes respiratory symptoms. However, an increasing number of cutaneous manifestations associated with this disease have been reported. The aim of this study is to analyze the scientific literature on cutaneous manifestations associated with SARS-CoV-2 by means of a narrative literature review until June 2021. The search was conducted in the following electronic databases: Medline (PubMed), SciELO, and Cochrane Library Plus. The most common cutaneous manifestations in patients with COVID-19 are vesicular eruptions, petechial/purpuric rashes, acral lesions, liveoid lesions, urticarial rash, and maculopapular-erythematous rash. These manifestations may be the first presenting symptoms of SARS-CoV-2 infection, as is the case with acral lesions, vesicular eruptions, and urticaria. In relation to severity, the presence of liveoid lesions may be associated with a more severe course of the disease. Treatment used for dermatological lesions includes therapy with anticoagulants, corticosteroids, and antihistamines. Knowledge of the dermatologic manifestations associated with SARS-CoV-2 contributes to the diagnosis of COVID-19 in patients with skin lesions associated with respiratory symptoms or in asymptomatic patients. In addition, understanding the dermatologic lesions associated with COVID-19 could be useful to establish a personalized care plan., Junta de Castilla y León - FEDER (n° 07.04.467804.74011.0)

This study presents the first application of convolutional neural networks to high-frequency ultrasound skin image classification. This type of imaging opens up new opportunities in dermatology, showing inflammatory diseases such as atopic dermatitis, psoriasis, or skin lesions. We collected a database of 631 images with healthy skin and different skin pathologies to train and assess all stages of the methodology. The proposed framework starts with the segmentation of the epidermal layer using a DeepLab v3+ model with a pre-trained Xception backbone. We employ transfer learning to train the segmentation model for two purposes: to extract the region of interest for classification and to prepare the skin layer map for classification confidence estimation. For classification, we train five models in different input data modes and data augmentation setups. We also introduce a classification confidence level to evaluate the deep model’s reliability. The measure combines our skin layer map with the heatmap produced by the Grad-CAM technique designed to indicate image regions used by the deep model to make a classification decision. Moreover, we propose a multicriteria model evaluation measure to select the optimal model in terms of classification accuracy, confidence, and test dataset size. The experiments described in the paper show that the DenseNet-201 model fed with the extracted region of interest produces the most reliable and accurate results.

RESUMEN En la presente investigación, se evaluó el quitosano aplicado en la piel. Se estudiaron sus bondades terapéuticas cicatrizantes en pacientes con lesiones y ulceraciones en la piel, agudas y crónicas, en un hospital público de la localidad de Puerto Cabello- Estado Carabobo, Venezuela. Se hizo una evaluación continúa tomando en cuenta la gravedad de las lesiones. Se utilizó un material en presentación de apósito (composición acetato de D-glucosamina al 1%) y gel tópico, aplicado a una población de nueve pacientes para evaluar su porcentaje en efectividad, en un número de semanas, de acuerdo a patologías médicas variadas. También se estudió el quitosano (gel, apósito) frente a semanas de tratamiento, llegando a la resolución de las lesiones a un 98.9%, en una duración de 2 a 5 semanas, con 100% de cura de tejido cicatricial y un 98% de resolución completa, aplicando 60% de gel de quitosano y 40% quitosano en apósito. Abstract In the present investigation, the chitosan applied to the skin was evaluated. Its therapeutic benefits were studied in patients with acute and chronic skin lesions, in a public hospital in the town of Puerto Cabello- Carabobo State, Venezuela. A continuous evaluation was made taking into account the severity of the lesions, a dressing presentation material (1% D-glucosamine acetate composition) and topical gel were used. It was applied to a population of nine (9) patients to evaluate their percentage (%) of effectiveness, in several weeks, according to various medical pathologies, chitosan (gel, dressing) was also studied, compared to weeks of treatment, resolving the lesions 98.9%, in duration from 2 to 5 weeks, with 100% healing of scar tissue and 98% complete resolution, applying 60% chitosan gel and 40% chitosan in dressing.

Tuberous sclerosis complex (TSC) is an autosomal dominant disorder with multisystemic involvement usually resulting from mutations in the tuberous sclerosis 1 (TSC1) or TSC2 genes. However, 10 to 25% of patients do not exhibit these mutations. Cerebral cavernous malformations (CCMs) are capillary-venous malformations that can be asymptomatic or cause variable neurological manifestations, including seizures. Familial CCMs are recognized. In both conditions, specific dermatological lesions are associated. We present the case of a 31-year-old female with TSC diagnosed at the age of 18 years who presented with negative genetic testing. She was admitted to our department in 2019 for a sudden increased frequency of focal seizures. Patient examination revealed multiple facial and intraoral angiofibroma, diplopia, right hemihypoesthesia, brisk deep tendon reflexes, and distal leg paresthesia. VideoEEG indicated a frontal paramedian epileptogenic focus. Cerebral magnetic resonance imaging (MRI) and angioMRI identified multiple fronto-parietal cortical tubers, as well as multiple CCMs, with evidence of bleeding in one. Under antiepileptic drug (AED) and mTOR inhibitor treatment, the seizure frequency significantly improved in a short period of time. This is the first reported case of tuberous sclerosis with negative genetic testing associated with multiple cerebral cavernoma. Such complex patients require multidisciplinary management and detailed genetic testing for increasing knowledge on neuro-cutaneous disorders.

Imagem hiperespectral (HSI) é um novo conceito de diagnóstico de doenças por análise de imagens. Embora existam muitas abordagens para a análise de imagens HSI, a classificação das informações espaciais para a classificação do tumor ainda é limitada. Nesta tese é proposta a construção de um novo método de análise e classificação de objetos presentes em HSI baseado em técnicas de aprendizado de máquina para entender o comportamento vibracional molecular de tecido epitelial humano sadio e tumoral por meio de espectroscopia de infravermelho de ondas curtas (SWIR). No estudo experimental são analisadas amostras de Melanoma, Nevo Displásico e Pele Saudável. Os resultados mostram que o tecido epitelial humano é sensível ao SWIR a ponto de possibilitar a diferenciação entre tecidos saudáveis e tumorais. Conclui-se que o HSI-SWIR pode ser utilizado para construir novos métodos de classificação tumoral. Hyperspectral Imaging (HSI) is a new concept of disease diagnosis by image analysis. Although there are many approaches for HSI image analysis, the classification of spatial informations to tumor classification is still limited. In this thesis is proposed the building of a new method of analysis and classification of present objects in HSI based on techniques of machine learning to understand the molecular vibrational behavior of healthy and tumoral human epithelial tissue by means of short-wave infrared (SWIR) spectroscopy. In the experimental study is analyzed samples of Melanoma, Dysplastic Nevus and healthy skin. Results show that human epithelial tissue is sensitive to SWIR to the point of making possible the differentiation between healthy and tumor tissues. It can be concluded that HSI-SWIR can be used to build new methods for tumor classification. Fundação de Amparo à Pesquisa do Estado de Goiás

Infantile systemic hyalinosis (ISH) is a rare, autosomal recessive disorder characterized by widespread abnormal growth of hyalinized fibrous tissue in skin and mucosae. The typical clinical picture consists of the development of joint contractures, skin lesions, and severe, chronic pain. We report the case of a 2-year-old Pakistani girl, who presented to our clinic with papulonodular lesions, gingival hyperplasia, hypotonia, and joint contractures. Skin biopsy revealed hyaline deposits, and genetic testing revealed a mutation in the protein Anthrax toxin receptor 2 (ANTXR2).

Ultrasound (US) represents the first-level imaging technique in the assessment of breast in young patients, whereas it is complementary to mammography in adult ones. It is not uncommon to encounter non-glandular mass during either screening or diagnostic breast US; sometimes the evaluation of palpable lump may be the reason of clinician's US request. The breast US field-of-view includes not only the glandular parenchyma, but also the tissues located anterior and posterior to it, from the skin to the ribs. In this setting, the radiologist must be familiar with the non-glandular breast diseases, which can occur in the superficial layers as well as in the chest wall. The differential diagnosis varies according to anatomic layer, so the anatomic origin is the first feature to assess and the correct localization is needed to avoid misdiagnosis and to choose, when requested, the second diagnostic step, imaging or histologic analysis. This paper is the first of two focused on non-glandular breast lesions; characterization, differential diagnosis, and pitfalls of superficial lesions are reviewed. They may be located in the dermis or hypodermis: the former are usually benign skin lesions, whereas the latter, although usually benign, may arise also from the anterior terminal lobular units, hence the papilloma, fibroadenomas, and breast cancers should be included in the differential diagnosis. US is more sensitive than CT and MRI in the assessment of superficial lesions due to higher spatial resolution.