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Jingya Zhang, Fei Qi, Xuan Zhang, Jie Dong, Chunguang Tong, Xiuying Zhang, Fang Liu Department of Dermatology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Fang Liu, Department of Dermatology, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongti South Road, Chaoyang District, Beijing, 100020, People’s Republic of China, Tel +86-10-85231688, Fax +86-10-85231217, Email roseliufang@qq.comAbstract: Sjögren’s syndrome (SJS) is a systemic disease in which the accumulated skin can include xeroderma, eyelid dermatitis, and annular erythema (AE). To the best of our knowledge, there are few reports on cases of SJS with concomitant lichen sclerosus (LS). Herein, we report the case of a 69-year-old woman with these two diseases. The patient’s skin showed atrophic leukoplakia and AE. Based on the comprehensive evaluation of general condition, the patient was diagnosed and actively received treatment. After systematic treatment, her symptoms were controlled. However, the patient’s condition requires long-term management.Keywords: annular erythema, skin atrophy, depigmentation, skin lesions

Norwegian scabies is a rare variant of scabies, which has clinical differences from the classical variant, which can cause diagnostic errors. Risk factors for developing the disease are various immunodeficiency states (HIV infection, malignant neoplasms, leprosy). A clinical case of the development of Norwegian scabies in a 22-year-old patient with HIV-infection stage 4B, with a level of CD4-lymphocytes in the blood of 8 cells/µl, is presented. The patient was hospitalized with complaints of weakness, skin rashes, itching and fever up to 40°C. On examination, there was dryness of the skin with erythematous areas on the arms, legs, and torso, as well as massive dirty-gray crusts on the skin of the scalp, torso, palms, elbows, dorsal surface of the feet. Purulent crusts were visualized on the elbows (Ardy’s symptom).Treatment of scabies was carried out by treating the skin with a solution of benzyl benzoate. Against the background of the therapy, there was a positive trend in the form of the disappearance of skin itching, unpleasant odor, and complete disappearance of crusts on the 7th day of treatment.

In the 2022 mpox (monkeypox) outbreak, 79,000 global cases have been reported. Yet, limited dermatologic data have been published regarding lesion morphology and progression. The objective of this study was to characterize skin lesion morphology, symptomatology, and outcomes of mpox infection over time. The American Academy of Dermatology/International League of Dermatological Societies Dermatology COVID-19, Mpox, and Emerging Infections Registry captured deidentified patient cases of mpox entered by health care professionals. From August 4 to November 13, 2022, 101 cases from 13 countries were entered, primarily by dermatologists (92%). Thirty-nine percent had fewer than 5 lesions. In 54% of cases, skin lesions were the first sign of infection. In the first 1-5 days of infection, papules (36%), vesicles (17%), and pustules (20%) predominated. By days 6-10, pustules (36%) were most common, followed by erosions/ulcers (27%) and crusts/scabs (24%). Crusts/scabs were the predominant morphology after day 11. Ten cases of morbilliform rash were reported. Scarring occurred in 13% of the cases. Registry-reported data cannot address incidence. There is a potential reporting bias from the predilection to report cases with greater clinical severity. These findings highlight differences in skin findings compared to historical outbreaks, notably the presence of skin lesions prior to systemic symptoms and low overall lesion counts. Scarring emerged as a major possible sequela. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The most frequent form of cancer around the world is skin cancer. When compared to unaided visual inspection, Dermoscopy image processing enhances diagnostic accuracy for detecting malignant melanoma and other pigmented skin lesions. Medical professionals are very interested in computer-based methods that assist in diagnosis. For the most deadly skin diseases, such as melanoma, there has been a lot of research and development into the best ways to detect them. Skin cancer that originates in the pigment-producing cells known as melanocytes, melanoma, is the most severe form of the disease. Melanoma evolution might include changes in size, form, colour, irritation, and even skin disintegration. There is a need for a novel strategy to enhance the contrast and fine details of Dermoscopy Images. This study proposes a multi-range morphological approach to reducing the detrimental impact of low contrast on image quality. The rise in the number of skin cancer cases prompted the creation of these new technologies. The images must be precisely segmented in order to characterize skin lesions. That information can be used by a classifier or a dermatologist to classify a lesion more accurately, making it easier for them to do so. Segmentation issues might arise when images are obtained in an unsystematic and uncontrolled manner. Dermoscopy skin lesion photos can be used to aid in the computeraided diagnosis of melanoma by automatically selecting a lesion border. Segmenting skin lesions is a challenge because of the wide range of photography techniques used in Dermoscopy Images. The proposed model introduced a Multi Range Morphological Model on Dermoscopy Images with Edge based Segmentation (MRMM-DI-EbS) for image quality enhancement for lesion classification. The proposed model is compared with the traditional model and the results show that the proposed model performance is high in image quality enhancement. [ABSTRACT FROM AUTHOR]

The number of deaths due to melanoma skin cancer has rapidly increased in recent years. The timely diagnosis of the lesions of melanoma skin cancer can potentially increase the survival rate of such a chronic disease. However, the detection of these lesions is a challenging task, especially in the presence of occlusions, such as clinical artifacts, blood vessels, and color contrast variation, etc. The current state-of-the-art detection and segmentation methods are based on fully convolutional neural networks, which utilize an encoder-decoder method. However, these methods produce coarse segmentation masks due to the loss of location information during the encoding layers. To overcome these challenges, this study proposes a highly effective Hybrid detection and segmentation method based on the integration of RetinaNet and MaskRCNN, which utilizes a pyramid module of lateral connections and top-down paths to compensate for the loss of spatial features information. The proposed method is trained and validated on Melanoma-ISIC-2018 and PH2 datasets. Experiment results on the unseen PH2 dataset illustrate the improved generalization ability of the method. The efficacy with other methods such as Encoder-Decoder, Generative Adversarial Network(GAN), UNet Deep Convolutional Neural Network-support vector machine(DCNN-SVM), Encoder-Fully Connected Network(EFCN), Enhanced Convolutional-Deconvolutional Networks(ECDNs), UNet, and Handcrafted has also been compared. The results, show that the proposed method outperforms above methods by 7.7%, 12.9%, 11.4%, 14.4%, 14.9%, 18.6%, 25.1%, respectively, in terms of accuracy. It is envisaged that with reliable accuracy, this method can be introduced for clinical practices in the future. [ABSTRACT FROM AUTHOR]

Mpox (formerly called monkeypox) is a zoonosis caused by the monkeypox virus (MPXV). MPXV is an orthopoxvirus genetically and antigenically similar to the variola virus responsible for smallpox. Mpox is endemic to Central and West Africa, but in 2022 it spread rapidly leading to many cases in non-endemic countries. Human-to-human contact is currently the main mode of transmission. Patients usually present with a prodromal syndrome of fever, myalgia, headache, lymphadenopathy, and fatigue. The characteristic centrifugal rash with mucocutaneous lesions develops 1-4 days later. Lesion evolution typically follows a sequence of changes (macules, papules, vesicles, pustules, and crusts). The disease is mostly mild and self-limiting. Distinct clinical presentations have been observed during the ongoing outbreak. Prodromal symptoms may be less pronounced or absent. Lesions are located predominantly in the anogenital and perioral areas. Patients may present with few lesions clustered in the genital region or a solitary lesion. Mpox diagnosis is usually confirmed through viral DNA detection with polymerase chain reaction (PCR). There is no specific treatment for mpox. Therapy remains supportive in most cases. Antiviral drugs include tecovirimat, cidofovir, and brincidofovir. Antibody-based therapies are another treatment option. Smallpox vaccines should be considered for high-risk patients (pre-exposure prophylaxis) and following high-risk exposures (post-exposure prophylaxis). Comprehensive differential diagnosis and screening for co-infections with other sexually transmitted pathogens are needed. [ABSTRACT FROM AUTHOR]

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Since May 2022, a Monkeypox virus (MPXV) outbreak has been ongoing in several non‐endemic countries. MPXV is usually transmitted after intimate contact, through body fluids, close contact from active lesions or through respiratory droplets. The recent outbreak occurrent in people with multiple recent sexual intercourse suggests the sexual route as the main way of transmission. However, there is no sufficient evidence to consider MPXV as a new sexually transmitted infection (STI), even though we believe that a link between MPXV and other STIs may exist with a possible facilitating action on their spreading. Herein, we illustrate the first case described during the current outbreak of a young man with both MPXV and acute HIV infection in a non‐endemic country. [ABSTRACT FROM AUTHOR]

We present here the case of a 55-year-old male patient with a past medical history of HIV infection on appropriate antiretroviral therapy (Bictegravir/Emtricitabine/Tenofovir Alafenamide), previously treated for hepatitis C with sustained viral response, who was diagnosed with squamous cell cancer of his right hand 2 years before, and treated with carboplatin and taxol, and surgery (partial amputation) for cancer progression and recurrent infections. He presented to our emergency department for worsening pain (NRS 10/10) of a suppurative and foul-smelling interdigital ulcerated lesion of his left foot, that had been present for 3 months. He reported 100% adherence to his HIV therapy and denied fever or chills. Initial work-up showed 10,690/mm3 leukocytes (8,240/ mm3 neutrophils, 1,560/mm3 lymphocytes), and a C-reactive protein of 2.89 mg/dL (normal value 0-0.5). CD4 count on presentation was 225 cells/µL. The patient was immediately treated with morphine (10 mg iv) and piperacillin/tazobactam (4.5 gr iv). The lesion presented erythematous ulcerated bleeding surface with serous and fetid secretion on which mobile larvae were found inside (as showed in the video). We removed about 20 maggots with blunt pliers, identified as larvae of Musca domestica (housefly).

A 65-year-old man presented to the emergency room with blistered not itching skin lesions on the dorsal surface of both hands, which developed recurrently after exposure to sun and solved spontaneously with scarring. The patient had a history of hypertension, diabetes mellitus type 2 and hypercholesterolemia. His medications included ramipril, metformin, simvastatin, and acetylsalicylic acid. He denied smoke, but he used to consume a large amount of alcohol (1 Lt of red wine daily). His body mass index was 29 (overweight). Blood exams revealed: altered glucose metabolism (fasting and post-prandial blood glucose, respectively 172 mg/dL and 267 mg/dL), macrocytosis (mean cell volume 100.6 fL), increased transaminases (AST 62 U/L and ALT 79 U/L, normal value 10-37) and gamma-glutamyl transferase (GGT 255 U/L, normal value 7-40), and an iron assessment as follows: serum ferritin 2234 ng/mL, transferrin saturation 40%, serum iron 138 mcg/dL. Hepatitis C, hepatitis B, and HIV were excluded. Autoimmune screening was negative. Point of care ultrasound documented a grade 3 liver steatosis.

Mueller polarimetry has proven to be a powerful optical technique to complement medical doctors in their conventional histology analysis. In this work, various degenerative and malignant human skin lesions were evaluated ex vivo using imaging Mueller polarimetry. The Mueller matrix images of thin sections of biopsies were recorded and the differential decomposition of Mueller matrices was applied pixel-wise to extract the polarization fingerprint of the specimens under study. To improve the classification accuracy, a deep learning model was created. The results indicate the sensitivity of polarimetry to different skin lesions and healthy skin zones and their differentiation, while using standard histological analysis as a ground truth. In particular, the deep learning model was found sufficiently accurate to detect and differentiate between all eight classes in the data set. Special attention was paid to the overfitting problem and the reduction of the loss function of the model. Our approach is an effort in establishing digital histology for clinical applications by complementing medical doctors in their diagnostic decisions.

Aim: We are reporting a case of an unusual presentation of granulomatosis with polyangiitis (GPA) with liver involvement. Case presentation: A 45-year-old male patient presented with erythematous plaques on the face and bilateral nasal obstruction. On physical examination, the patient had a ring-shaped squamous plaque on the face. The laboratory findings revealed an accelerated erythrocyte sedimentation rate at 100 mm/h, an elevated C-reactive protein at 66 mg/L, hyper gamma globulinemia 16 g/L and an elevated alkaline phosphatase (twice the upper normal limit). The craniofacial and thoracoabdominal computed tomography (CT) -scans showed ethmoid and maxillary sinusitis, low facial bone density, multiple mediastinal and hilar lymphadenopathy, diffuse small pulmonary nodules, and hepatomegaly. A cutaneous lesion biopsy, the nasal mucosa, and the liver showed a chronic inflammatory granulomatosis process with necrosis. Serum anti-neutrophil cytoplasmic antibody (ANCA) against PR3 was positive. The clinical, biological, radiological, and histological findings substantiated the diagnosis of GPA. The patient received systemic steroids combined with cyclophosphamide pulses on days 1, 14 and 28 and then he was lost to follow-up. Two-years later, he presented with a cardiac failure and skin ulcer in the right lower limb. A nasal endoscopic exam showed nasal septum cartilage perforation with resorption of the middle and inferior nasal concha. Two weeks later, he developed a diffuse alveolar hemorrhage and was therefore transferred to the intensive care unit but died of respiratory failure 3 days later. Conclusion: Clinicians should be aware of GPA atypical clinical manifestations.

Aim: We are reporting a case of an unusual presentation of granulomatosis with polyangiitis (GPA) with liver involvement. Case presentation: A 45-year-old male patient presented with erythematous plaques on the face and bilateral nasal obstruction. On physical examination, the patient had a ring-shaped squamous plaque on the face. The laboratory findings revealed an accelerated erythrocyte sedimentation rate at 100 mm/h, an elevated C-reactive protein at 66 mg/L, hyper gamma globulinemia 16 g/L and an elevated alkaline phosphatase (twice the upper normal limit). The craniofacial and thoracoabdominal computed tomography (CT) -scans showed ethmoid and maxillary sinusitis, low facial bone density, multiple mediastinal and hilar lymphadenopathy, diffuse small pulmonary nodules, and hepatomegaly. A cutaneous lesion biopsy, the nasal mucosa, and the liver showed a chronic inflammatory granulomatosis process with necrosis. Serum anti-neutrophil cytoplasmic antibody (ANCA) against PR3 was positive. The clinical, biological, radiological, and histological findings substantiated the diagnosis of GPA. The patient received systemic steroids combined with cyclophosphamide pulses on days 1, 14 and 28 and then he was lost to follow-up. Two-years later, he presented with a cardiac failure and skin ulcer in the right lower limb. A nasal endoscopic exam showed nasal septum cartilage perforation with resorption of the middle and inferior nasal concha. Two weeks later, he developed a diffuse alveolar hemorrhage and was therefore transferred to the intensive care unit but died of respiratory failure 3 days later. Conclusion: Clinicians should be aware of GPA atypical clinical manifestations.

Skin lesions in systemic lupus erythematosus (SLE) are not just a cosmetic defect, accompanied by a deterioration in the quality of life and psychological discomfort, but, possibly, the first sign of a systemic course of disease. Systemic involvement can develop in patients with almost any type of cutaneous lupus erythematosus (CLE), requiring the study of CLE in combination with SLE. Dermatologists are the first to face with skin manifestations of SLE, while other organs and systems affection leads the patient to a rheumatologist. It is important to understand that skin lesions do not cause irreversible organ damage, but continuity of therapeutic approaches between a dermatologist and a rheumatologist is necessary. The review presents the clinical signs, diagnostic features and histological characteristics of CLE.

Abstract Background Psoriasis is a chronic inflammatory skin disease. Tissue stem cells have exhibited a therapeutic effect on psoriatic mice. However, the therapeutic effect of topical administration of the secretome derived from tissue stem cells on psoriasis has not been reported. Methods The secretome from human amniotic epithelial cells (AEC-SC) and human umbilical cord mesenchymal stem cells (UMSC-SC) was topically administrated on the back of imiquimod-induced psoriasis-like mice. Subsequently, we observed the skin lesions and skin inflammation of psoriasis-like mice. Next, we further analyzed the paracrine factors in AEC-SC and UMSC-SC by protein chips. Lastly, the effect of the crucial paracrine factor was investigated by imiquimod-induced psoriasis-like mice. Results We found that AEC-SC had a better therapeutic effect on attenuating psoriasis-like skin lesions including skin scales, skin redness and skin thickness than UMSC-SC, and it had a better regulatory effect on keratinocyte hyperproliferation and altered differentiation. Thus, we focused on AEC-SC. Further study showed that AEC-SC reduced the infiltration of neutrophils and interleukin-17-producing T cells. Next, the analysis of AEC-SC with protein chip revealed that the levels of anti-inflammatory factor interleukin-1 receptor antagonist (IL-1ra) were much higher in AEC-SC compared to that in UMSC-SC. More importantly, the beneficial effect of AEC-SC on psoriasis-like skin lesions and skin inflammation of mice were significantly impaired when neutralizing with IL-1ra antibody, while the recombinant human IL-1ra showed a less protective effect than AEC-SC. Conclusions The present study demonstrated that AEC-SC could efficiently ameliorate psoriasis-like skin lesions and skin inflammation and IL-1ra plays an essential role. Therefore, topical administration of AEC-SC may provide a novel strategy for treating psoriasis-like inflammatory skin diseases.

Introduction: Scrub typhus is a vector-borne zoonotic disease caused by Orientia tsutsugamushi, obligate intracellular gram negative bacteria. It is transmitted by the larval stage of mites (“chiggers”) in the family Trombiculidae. The disease is endemic in many parts of India and continues to be a public health problem. Aim: To study the clinical and demographic characteristics of the scrub typhus patients in a peripheral medical college of West Bengal, India. Materials and Methods: Present study was a retrospective study enrolling 66 confirmed positive cases with Enzyme Linked Immunosorbent Assay (ELISA) test during the period from 1st September 2021 to 31st December 2021 at Department of Microbiology, Rampurhat Government Medical College and Hospital, Rampurhat, West Bengal, India. Results: The clinical and demographic characteristics of the scrub typhus patients’ majority were below age of 15 years i.e. (72.7%), in which females (65.2%) were more compared to male (34%). Most of the study participants were from rural area (76.8%). Majority of study subjects presented with fever (94%), fever with chills (36.4%), cough (24.2%), altered sensorium (25.8%). Maximum cases 42 (63.6%) had occurred in the month of September followed by 11 (16.7%) in October, and November and 02 (3.0%) case reported in December 2021. About 15.3% study population had expired where as 84.7% survived. Conclusion: Current study shows that majority of the cases occurred in the month of September 2021 with female preponderance. Most of the residents were from rural areas with common clinical symptoms with fever with or without chills and breathlessness, headache, altered sensorium and skin lesions

Skin and mucous membranes lesions in systemic lupus erythematosus (SLE) significantly impair the quality of life of patients, although they are not a formidable manifestation of the disease. Skin manifestations of SLE can occur both at the onset and on the late stage of the disease. Although skin and mucous membranes lesions are clearly grouped in the latest classification criteria for SLE, verification of the diagnosis requires a multidisciplinary approach. In the etiology of SLE, environmental factors, hormonal factors, and genetic predisposition play a role. Further research will reveal differences in subtypes of cutaneous lupus erythematosus and will facilitate the development of new therapies.

Background Treatment with nemolizumab plus topical corticosteroids (TCS) and/or topical calcineurin inhibitors (TCI) achieved improvements in itch and sleep (measured using Peak Pruritus Numerical Rating Scale and Sleep Disturbance Numerical Rating Scale) at Week (W) 16 and maintained them up to W48 in patients with moderate-to-severe AD.1,2 Objectives To evaluate the efficacy of nemolizumab in maintaining itch and sleep responses (using SCORing Atopic Dermatitis (SCORAD) Visual Analog Scale [VAS] Pruritus and SCORAD VAS Sleep) over 48 weeks in patients with moderate-to-severe AD. Methods We analyzed 32-week maintenance data pooled from two double-blinded, placebo-controlled, phase 3 studies (ARCADIA-1 and ARCADIA-2). Clinical responders (those achieving IGA 0/1 or EASI-75 at W16) were re-randomized (1:1:1) to receive nemolizumab 30mg every 4 weeks (nemolizumab-Q4W), nemolizumab 30mg every 8 weeks (nemolizumab-Q8W), or placebo Q4W (nemolizumab-withdrawal arm) subcutaneously, all with TCS and/or TCI up to W48. Results At W48, response rates for ≥4-point improvement in SCORAD VAS Pruritus were maintained in nemolizumab-Q4W (72.8%, p <0.0001) and nemolizumab-Q8W (66.9%, p ≤0.001) vs placebo (49.1%) groups. Similarly, response rates for ≥4-point improvement in SCORAD VAS Sleep were maintained in nemolizumab-Q4W (61.5%, p <0.001) and nemolizumab-Q8W (56.2%, p <0.05) vs placebo (43.2%) groups at W48. Response rates for SCORAD VAS Pruritus-75 (≥75% improvement in VAS Pruritus from initial baseline) were also maintained in nemolizumab-Q4W (63.3%, p <0.0001) and nemolizumab-Q8W (58.6%, p <0.0001) vs placebo (37.3%) groups at W48. Similar maintenance of response rates for SCORAD VAS Sleep-75 (≥75% improvement in VAS Sleep from initial baseline) was noted in nemolizumab-Q4W (60.4%, p <0.01) and nemolizumab-Q8W (56.8%, p <0.05) vs placebo (43.8%) groups at W48. Conclusions Treatment with nemolizumab plus TCS/TCI maintained rate of improvements in itch and sleep through W48 in patients who achieved clinical response at W16. The Q8W regimen was similar to Q4W in maintenance of the rate of itch and sleep response. [ABSTRACT FROM AUTHOR]

Nowadays, zoos and aquariums, along with the constant advancement of sociocultural moral values, are proactively committed to ensuring and safeguarding cetacean health standards. This entails developing new approaches to health assessments by embracing minimally invasive sampling methods and enhanced animal handling and management, among other aspects. Hence, in the present survey, to appraise skin diseases, the implementation of cytology cell samplers as a non-invasive skin sampling device on 18 bottlenose dolphins housed in two facilities in the Canary Islands during the months of April, October, and December 2019 was performed to isolate cetacean poxvirus in tattoo-like lesions through a real-time PCR-based method using the DNA polymerase gene. Samples were repeatedly collected over time from eleven tattoo-like lesions and from apparently healthy skin to serve as a control for all study animals. From a total of 55 skin samples, detection of the poxvirus was attained in 31 (56.36%); specifically, on 20 of 21 samples collected from tattoo-like lesions (95.23%) and on 11 of 34 samples acquired from apparently healthy skin (32.35%). Correspondingly, the current study constitutes the first report of the isolation of cetacean poxvirus in skin samples without macroscopical signs of tattoo lesions in cetaceans. Likewise, ten of the eleven dolphins that showed tattoo lesions housed in Facility 1 were positive for tattoo skin disease, while four dolphins held in Facility 2 were positive for cetacean poxvirus without ever showing clinical evidence of the disease. This raises the question of whether this pathogen can produce latent infections and whether progression of the disease may depend on environmental stimuli, viral load, or the good health/immunological status of individual animals. Accordingly, further scientific research on cetaceans under human care could provide the knowledge, skills, and resources to understand the host–pathogen dynamics of cetacean poxviruses and their effect on cetaceans’ health.

We have previously reported that pathogenic variants in a key metabolite repair enzyme NAXD cause a lethal neurodegenerative condition triggered by episodes of fever in young children. However, the clinical and genetic spectrum of NAXD deficiency is broadening as our understanding of the disease expands and as more cases are identified. Here, we report the oldest known individual succumbing to NAXD-related neurometabolic crisis, at 32 years of age. The clinical deterioration and demise of this individual were likely triggered by mild head trauma. This patient had a novel homozygous NAXD variant [NM_001242882.1:c.441+3A>G:p.?] that induces the mis-splicing of the majority of NAXD transcripts, leaving only trace levels of canonically spliced NAXD mRNA, and protein levels below the detection threshold by proteomic analysis. Accumulation of damaged NADH, the substrate of NAXD, could be detected in the fibroblasts of the patient. In agreement with prior anecdotal reports in paediatric patients, niacin-based treatment also partly alleviated some clinical symptoms in this adult patient. The present study extends our understanding of NAXD deficiency by uncovering shared mitochondrial proteomic signatures between the adult and our previously reported paediatric NAXD cases, with reduced levels of respiratory complexes I and IV as well as the mitoribosome, and the upregulation of mitochondrial apoptotic pathways. Importantly, we highlight that head trauma in adults, in addition to paediatric fever or illness, may precipitate neurometabolic crises associated with pathogenic NAXD variants. [ABSTRACT FROM AUTHOR]

The advancement in technology also upgraded the biomedical field and enhanced the diagnostic system performance, where medical imaging plays its inevitable role. Several image processing techniques created the medical systems automated and meticulous. These systems nowadays support physicians in identifying adverse diseases like cancer, tumor, and skin diseases. In this imaging, features have a significant role in visually performing the diagnostic and finding the suffered area. Moreover, it also improves the performance of the automatic recognition systems used in the medical field. The researchers proposed various feature extraction techniques that use color, texture, and shape-based features in image processing systems but not every feature is best suited for medical imaging. This paper covers the objective of providing a Fast and Indented Feature Extractor (FIFE) for the health care sector's future. This proposed extractor extracts only relevant shape features for processing to reduce processing time and improve the result's quality. The image samples are taken for a skin disease named skin lesions for this work. The dataset of ISIC and PH2 is used in this work for analysis. This FIFE works on multiple feature extraction approaches and blends them to form a distinct extraction level. The indentation level one, two, three, and four are used in this work using four different shape descriptors, namely SURF, FAST, BRISK, and ORB. The performance comparison of the proposed indentation levels is based on the number of features and time. The experimentation results are evaluated with qualitative and quantitative measures that reveal the proposed extractor's efficiency. [ABSTRACT FROM AUTHOR]

Precise segmentation for skin cancer lesions at different stages is conducive to early detection and further treatment. We propose a weakly supervised semantic segmentation algorithm (CNN-SRR) for dermoscopy images through CNN responding superpixel regions, given that the substantial cost of obtaining perfect pixel annotation for these tasks. CNN-SRR combines a modified classifier based on deep learning and unsupervised superpixel algorithm. The former leverages abundant image-level labeled data to tune parameters to focalize on lesion regions. The extraction of lesion region responses consists of two stages, training a modified CNN classifier and back-propagate peak values of the classifier top layer. Afterward, a test image is over-segmented to a set of primitive superpixels that are merged into a few regions as proposals, several of which are activated as the segmented mask by lesion region responses via non-maximal suppression. Quantified experiments on ISBI2017 and PH2 datasets prove that the proposed algorithm can effectively discriminate lesion regions and the segmentation results even achieve competitive accuracy to the supervised segmentation approaches. We evaluate the proposed CNN-SRR algorithm on ISBI2017 and achieve that the Jaccard coefficient and Accuracy of segmentation task are improved by 12.4% and 3.3% compared with the unsupervised superpixel segmentation algorithm. [ABSTRACT FROM AUTHOR]

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 Staphylococcus aureus. 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. [ABSTRACT FROM AUTHOR]

Introduction: Pyoderma is a common health problem characterised by pyogenic infections of the skin and its appendages. Though easily treatable, the condition is known for its chronicity, recurrence and other complications. Therefore, timely recognition and prompt bacterial diagnosis with antimicrobial sensitivity is imperative for the effective management and treatment of pyoderma. It is a common bacterial skin infection accounting for nearly 25% of patients attending Dermatology Outpatient Department (OPD) in India and other tropical countries. Aim: To determine the incidence of pyoderma in relation to age, sex and socio-economic status, to isolate and identify the common aerobic microbial pathogens associated with pyoderma prevalent in the community and antibiotic susceptibility pattern. Materials and Methods: An institutional based crosssectional observational study was conducted on 148 cases in Department of Microbiology, Rampurhat Government Medical College and Hospital, Burdwan, West Bengal, India, clinical features of suspected pyoderma for a period of 12 months from March 2021 to February 2022. Lesion swabs were collected and isolates were identified; antibiotic susceptibility testing was also performed according to Clinical and Laboratory Standards Institute (CLSI) guidelines using antibiotic discs. Descriptive data was presented as count and percentages. Results: Out of 148 samples collected 144 (97.3%) were culture positive while, rest 04 (2.7%) were culture negative. Overcrowding and low socio-economic group were closely related with pyoderma patients. Primary pyoderma (72.2%) cases were detected more than the secondary (27.8%) cases. Impetigo contagiosa (54%) were detected more among the primary pyoderma patients. High numbers (66.7%) of pyoderma were detected among children (0 to 10 years). The culture positive samples were more in male patients (68.7%) than in female patients (31.3%) and mostly detected from OPD. Out of 144 isolates, 89 (61.8%) were Staphylococcus aureus, 23 (15.9%) isolates were Coagulase Negative Staphylococci (CoNS) and 04 (2.8%) were Streptococcus pyogens. Further 06 (4.2%) isolates of Pseudomonas aeruginosa, 10 (6.9%) isolates of Escherichia coli and 08 (5.5%) isolates of Klebsiella pneumonia were found. Conclusion: The present study results suggest that the era of antibiotics has ushered in an unprecedented predominance of Staphylococcal rather than Streptococcal infections and other gram negative infections for pyoderma cases. Increasing incidence of methicillin, quinolones and amikacin resistance in Staphylococci and other gram negative isolates have limited treatment options. For this, a single infection like pyoderma is challenging in all the healthcare facility. [ABSTRACT FROM AUTHOR]

Purpose: The main purpose of this study is to explore characteristics of patients with chronic kidney disease in tuberous sclerosis (TSC) and to underline differences in clinical characteristics between end-stage renal disease (ESRD) patients and patients in earlier stages of chronic kidney disease. Methods: This multicentric, retrospective study included data for 48 patients from seven South-Eastern European countries (Albania, Bosnia and Herzegovina, Croatia, Greece, Montenegro, Serbia, Slovenia) in the period from February to August 2020. Researchers collected data from local and national nephrological and neurological registries and offered clinical and laboratory results from medical histories in follow-up periods. Results: This study enrolled 48 patients with a median age of 32.3 years (range, 18–46 years), and predominant female gender (60.45%). The percentage of patients with chronic kidney disease (CKD) diagnosis of the total number of patients was 66.90%, with end-stage renal disease development in 39.6%. The most prevalent renal lesions leading to chronic kidney disease were angiomyolipomas (AMLs) in 76.6%, while multiple renal cysts were present in 42.6% of patients. Nephrectomy was performed in 43% of patients, while the mTOR inhibitors were used in 18 patients (37.5%). The majority of patients had cutaneous manifestations of tuberous sclerosis—83.30% had hypomelanotic cutaneous lesions, and 68.80% had angiofibromas. Multiple retinal nodular hamartomas and "confetti" skin lesions were more frequent in end-stage renal disease (ESRD) than in patients with earlier stages of chronic kidney disease (p-0.033 and 0.03, respectively). Conclusion: Our study has also shown that retinal hamartomas and "confetti" skin lesions are more frequent in end-stage renal diseases (ESRD) patients than in other chronic kidney disease (CKD) patients. Usage of mTOR inhibitors can also reduce the number of complications and associated with tuberous sclerosis, such as dermatological manifestations and retinal hamartoma, which are more common in the terminal stage of chronic kidney disease. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD) is a chronic inflammatory skin disease with significant health/economic burdens. Existing therapies are not fully effective, necessitating development of new approaches for AD management. Here, we report that dietary grape powder (GP) mitigates AD-like symptoms in 2,4-dinitrofluorobenzene (DNFB)-induced AD in NC/NgaTndCrlj mice. Using prevention and intervention protocols, we tested the efficacy of 3% and 5% GP-fortified diet in a 13-weeks study. We found that GP feeding markedly inhibited development and progression of AD-like skin lesions, and caused reduction in i) epidermal thickness, mast cell infiltration, ulceration, excoriation and acanthosis in dorsal skin, ii) spleen weight, extramedullary hematopoiesis and lymph nodes sizes, and iii) ear weight and IgE levels. We also found significant modulations in 15 AD-associated serum cytokines/chemokines. Next, using quantitative global proteomics, we identified 714 proteins. Of these, 68 (normal control) and 21 (5% GP-prevention) were significantly modulated (=2-fold) vs AD control (DNFB-treated) group, with many GP-modulated proteins reverting to normal levels. Ingenuity pathway analysis of GP-modulated proteins followed by validation using ProteinSimple identified changes in acute phase response signaling (FGA, FGB, FGG, HP, HPX, LRG1). Overall, GP supplementation inhibited DNFB-induced AD in NC/NgaTndCrlj mice in both prevention and intervention trials, and should be explored further. [ABSTRACT FROM AUTHOR]

Simple Summary: On commercial farms, adult female rabbits (does) are usually kept in single cages without direct contact with conspecifics other than their kits. However, wild rabbits live together in groups with several adults and their kits, and single housing of adult domestic rabbits may affect both, their own welfare and the welfare of their kits. In this study, we focused on the welfare of kits and compared three different housing systems for does and their kits: single housing of does with their respective kits; pairs of does with their kits; and groups of three does with their kits. The kits' health and stress level were analyzed. The number of kits with skin lesions increased with increasing group size. However, when does were pair-housed, kits seemed to have fewer disease symptoms compared to the other treatments. With regard to the stress level, there was no clear result; however, kits in groups of three does did tend to have higher stress hormones in hair. We conclude that pair housing for does could be an alternative to single housing when considering the welfare of their kits. Further studies are needed to evaluate both, the effects of pair housing on kits and does. In intense breeding programs, rabbits are exposed to numerous stress factors which could affect their welfare and health. It has been suggested that group housing is more comfortable for does and similar to the living conditions of European wild rabbits. In this study, we compared three different housing systems—single housing; housing in pairs; and housing in groups of three does—to test whether there is a measurable impact on skin lesions, health, and hair corticosterone concentration (HCC) of their kits. The number of kits with lesions increased with the number of does kept together. The probability of kits getting injured was higher in groups of three does than in pens of single-housed does (p = 0.041). When does were pair-housed, kits seemed to have fewer disease symptoms compared to the other treatments. Concerning HCC of kits, there was no significant difference between the housing systems (p > 0.05). The mean HCC of kits was 2.94 pg/mg, while pair housing had the lowest HCC (2.59 pg/mg). This study focused on the welfare of kits from group-housed does. From this perspective, pair housing of does may be appropriate to allow social interaction between does without unduly affecting the welfare of their kits. [ABSTRACT FROM AUTHOR]

In this study, an innovative hybrid machine learning‐technique is used for the early skin cancer diagnosis fusing Convolutional Neural Network and Multilayer Perceptron to analyze images and information related to the skin cancer. This information is extracted manually after applying different color space conversions on the original images for better screening of the lesions. The proposed architecture is compared with standalone architecture in addition to some other techniques by commonly used evaluation metrics. HAM10000 dataset is used for training and testing as this data contain seven different skin lesions. The novelty of the proposed hybrid model is the structure of the network which handles structured data (patients' metadata and other useful features from different color spaces related to the illumination, energy, darkness, etc.) and unstructured data (images). The results show an overall 86%, 95% top‐1 and top‐2 accuracy respectively, and 96% area under the curve for the seven classes. The study demonstrates the superiority of the proposed hybrid model with a 2% improvement in the accuracy over the standalone model and a promising behavior as compared to the ensemble techniques. The follow‐up research will include more patient data to develop a skin cancer detection device. [ABSTRACT FROM AUTHOR]

Biological therapy is used in a wide range of medical settings. Adverse reactions to biological therapy can limit their widespread use, so early detection and treatment can adjust attempts to stop these molecules. TNF Alpha blockers may cause the following skin reactions in alpha patients: injection site reactions, infections, immune-mediated reactions (psoriasis, psoriasis, drug-induced lupus, vasculitis, hidradenitis, alopecia), allergic or neoplastic reactions. We present the case of a patient with RA who developed skin lesions during biological therapy and was diagnosed with drug-induced lupus based on clinical elements, associated autoimmunity, and dermatological evaluation. The skin lesions were attributed to the interaction of three medications (biosimilar Etanercept, Leflunomide, and Isoniazid), all of which have been implicated in causing these side effects. The solutions that saved the patient were temporarily discontinuing the immunosuppressive medication and replacing it with a local corticoid, followed by the continuation of Etanercept in associated with Methotrexate, and the patient was able to continue the biological medication and obtain a favorable response to the treatment. In conclusion, skin changes caused by TNF Alpha inhibitors are common, but vary in severity, and do not warrant therapy interruption. [ABSTRACT FROM AUTHOR]

Objective Mycosis fungoides (MF) is a condition of the lymphatic tissues that mostly affects the skin (primary cutaneous T cell lymphoma), the most prevalent form of T-cell skin lymphoma. Central lymph node and other organs involvement are very poor prognostic factors that can gradually affect the quality of life of these patients. Therefore, in this study, we aimed to examine the quality of life in patients with MF. Methods In this descriptive study, a demographic questionnaire including age, gender, duration of MF, stage of the disease, and location of the lesion was completed. All participants were tested for quality of life using the SF36 questionnaire. Results There was a significant difference between different stages of the disease as well as the duration of the disease with respect to the overall quality of life score and its subscales, so that with increasing stage and duration of the disease, the quality of life decreased (P <0.05). The quality of life was lower in patients with sun-exposed areas than in those with other affected areas (P <0.05). Conclusion MF disease is correlated with reduced quality of life and the extent of which is inversely related to the duration of the disease as well as the stage of the disease. Additionally, patients with affected areas that are exposed to sunlight have a lower quality of life than those with other affected areas. [ABSTRACT FROM AUTHOR]

Mpox Virus (MPXV) is a zoonotic infectious disease first identified in 1970 in rural villages in rainforest areas of central and western Africa when smallpox was in the final stages of eradication. Since May 2022, cases and sustained transmission chains of monkeypox have been reported for the first time in countries where the disease is not endemic and without cases having direct or immediate epidemiological links to areas of West or Central Africa (travel, importation of mammals). On 23 July 2022, WHO declared monkeypox a "Public Emergency of International Concern" (PHEIC). In this paper, we report two cases of a Polymerase Chain Reaction (PCR)-confirmed MPXV infection. A 39-year-old Italian male came to our attention for a suspected herpetic infection, fever, headache, and malaise, which were followed by the development of an erythematous plaque covered by vesicles on the chin, an oval ulcer with a white peripheral border on the lower lip, and a central erosive area and three pustules on the arms and trunk. During the physical examination, cervical lymphadenopathy was also detected. PCR investigation of the patient and his partner confirmed the presence of MPXV infection. Our report describes a possible clinical feature of Mpox disease and illustrates the challenge of a disease that seems to present itself in different ways. [ABSTRACT FROM AUTHOR]

Dogs and cats may suffer from a variety of diseases, mainly immune mediated, that require the administration of immunosuppressive drugs. Such therapies can cause adverse effects either by the toxicity of the drugs or as a consequence of immune suppression and associated opportunistic infections. Here we present an, yet unknown, association of Toxoplasma gondii and Alternaria fungus, within cutaneous lesions in a dog under long-term immunosuppressive therapy. The diagnosis of such infections is laborious and not obvious at first glance, since the clinical signs of cutaneous toxoplasmosis, neosporosis or alternariosis are not specific. A further laboratory confirmation is needed. Therefore, we currently recommend that dogs and cats should undergo serologic testing for toxoplasmosis or neosporosis prior to immunosuppressive therapy and a regular dermatological evaluation during the immunosuppressive therapy. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Typically, skin lesions caused by monkeypox (MPX) begin as a monomorphic exanthema with centrifugal distribution, and can be found at different sequential stages in different regions of the body. The aim of this study is to present an atypical case of MPX infection that simultaneously presented exanthema at three stages of evolution in the same location. This is a descriptive study of a confirmed case of MPX by detection of the virus genome in clinical sample by polymerase chain reaction. We describe a 40-year-old male patient with an unusual clinical presentation. One week after having multiple risky MSM sexual intercourses, the patient developed skin eruption on the penis. During the following 10 days, he progressively developed new lesions on the same area. These lesions simultaneously showed different stages of evolution (vesicles, pustules and crust). Contrary to expected clinical presentation of the disease, the patient developed lesions at different stages in the same location. Attending physicians must be aware of atypical initial presentation and evolution of the lesions, and conduct a comprehensive epidemiological survey. [ABSTRACT FROM AUTHOR]

The semi-enclosed environment of the St Vincent Gulf Bioregion and its fauna are impacted by many human activities. Long-term monitoring of cetaceans is vital. Records of collected specimens (173) and those not examined by the South Australian Museum (98 non-specimens) from 2009–2020 were analyzed. Necropsies were carried out on most carcasses using gross, histopathological, and diagnostic assessment of pathogens, organs, and skin lesions. The relative age and circumstance of death were assigned. Baleen whales (five species) and odontocetes (eight species) were studied. Indo-Pacific bottlenose dolphins (Tursiops aduncus) and common dolphins (Delphinus delphis) were frequently recorded and analyzed in detail. Anthropogenic cases were prevalent (21%). Many dolphins (62%) were immature males. Disease (73%) was the most frequently recorded circumstance of death. The most common pathological change was inflammatory disease, including infectious pneumonia. In Indo-Pacific bottlenose dolphins, infectious disease was more prevalent in the greater St Vincent Gulf Bioregion than in the Adelaide Dolphin Sanctuary. Microbe testing confirmed 32 species of bacteria, 2 fungi, and 1 virus. Nematodes and trematodes were recorded throughout the study, sometimes in association with microbes. Toxoplasma gondii was observed in an Indo-Pacific bottlenose dolphin. Severe traumatic injury was recorded in many dolphins, including anthropogenic cases. A tumor (leiomyoma) was described from a single common dolphin. This study provides an important baseline for the future monitoring of emerging infectious and chronic diseases, and anthropogenic threats in the region. [ABSTRACT FROM AUTHOR]