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Shazia Ali,1,2 Faten AL Bukhari,3 Khaled Al Nuaimi,4 Hossam Elenany,5 Nabil Fakih-Gomez,6 Sahar Ghannam,7 Rami Haidar,8 Nicanor Isse,9 Nancy Labib,9 Afshin Mosahebi,10 Simon Ravichandran,11 Mohammed G Turkmani,12 Christeen Youssef13 1Department of Dermatology, University of Wales College of Medicine, Cardiff, Wales, UK; 2TrueMe Medical Centre, Jeddah, Kingdom of Saudi Arabi; 3Department of Dermatology, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia; 4Department of Dermatology, College of Medicine, Sharjah University, Sharjah, United Arab Emirates; 5Department of Dermatology and Aesthetic Medicine, DaO Derma, Cairo, Egypt; 6Department of Facial Plastic Surgery, Fakih Hospital, Khaizaran, Lebanon; 7Department of Dermatology, Alexandria University, Alexandria, Egypt; 8Skin Experts Polyclinic, Dubai, United Arab Emirates; 9Department of Dermatology, Medcare Hospital and Clinics, Dubai, United Arab Emirates; 10Department of Plastic Surgery, Royal Free Hospital, London, UK; 11Clinetix Rejuvenation Ltd, Glasgow, Scotland; 12Derma Clinic, Riyadh, Kingdom of Saudi Arabi; 13Everlast Wellness Medical Center, Abu Dhabi, United Arab EmiratesCorrespondence: Simon Ravichandran, Clinetix Rejuvenation Ltd, Glasgow, Scotland, Email simonravi@clinetix.co.ukBackground: Aesthetic minimally invasive procedures have become very popular and culturally acceptable among Middle Eastern populations. Botulinum neurotoxin type A (BoNTA) is a valuable treatment modality for many cosmetic as well as therapeutic indications. The presence of BoNTA in our toolkit has revolutionized the field of aesthetic medicine to the point where it is now one of the most commonly performed cosmetic procedures worldwide. This consensus considers popular on- and off-label BoNTA indications in the Middle East.Methods: A multinational group of ten key opinion leaders, experts in facial plastic surgery and dermatology, convened the Middle East Aesthetics Consensus Group and reviewed the aesthetic applications of BoNTA. Recommendations and position statements were drafted based on the integration of the panel’s clinical experience with published data, targeted to the practices implemented in the Middle Eastern and the global population.Results: Guidance statements are presented covering Middle Eastern facial characteristics and beauty ideals, BoNTA characteristics, pre-operative counselling, treatment indications and anatomical considerations, off-label and special uses including high-dose recommendations, and post-treatment advice. Throughout, an evidence-based approach to selection of products and injection techniques is provided, supplemented by the experts’ advice on injections dosages and placement.Conclusion: This consensus reflects the knowledge and expertise of physicians practicing in the Middle East. The panel acknowledged the use of on-label indications and variability in the toxin formulations and immunogenicity and agreed upon a wide use of “off-label” indications.Keywords: aesthetic use, botulinum neurotoxin type A, consensus, Middle East

Background: Acne, a commonly treated skin disease, requires patient-centered management due to its varying presentations, chronicity, and impact on health-related quality of life. Despite this, evidence-based clinical guidelines focus primarily on clinical severity of facial acne, omitting important patient- and disease-related factors, including ongoing management., Objectives: To generate recommendations to support patient-centered acne management, which incorporate priority and prognostic factors beyond conventional clinical severity, traditionally defined by grading the appearance and extent of visible lesions., Methods: The Personalizing Acne: Consensus of Experts consisted of 17 dermatologists who used a modified Delphi approach to reach consensus on statements regarding patient- and treatment-related factors pertaining to patient-centered acne management. Consensus was defined as ≥75% voting "agree" or "strongly agree.", Results: Recommendations based on factors such as acne sequelae, location of acne, high burden of disease, and individual patient features were generated and incorporated into the Personalized Acne Treatment Tool., Limitations: Recommendations are based on expert opinion, which may differ from patients' perspectives. Regional variations in healthcare systems may not be represented., Conclusions: The Personalizing Acne: Consensus of Experts panel provided practical recommendations to facilitate individualized management of acne, based on patient features, which can be implemented to improve treatment outcomes, adherence, and patient satisfaction., Competing Interests: All panel members received honoraria from Galderma for participating in this project. Alison M Layton has acted as an advisor or consultant, been chief investigator for research (funded to institution) and/or received honoraria for unrestricted educational events from Almirall, Beiersdorf, Cipher Pharmaceuticals, Galderma, GlaxoSmithKline, La Roche-Posay, LEO Pharma, L’Oreal, Mylan, Origimm, and Proctor and Gamble. Andrew Alexis has received grant/research support (funds to institution) from Abbvie, Almirall, Amgen, Arcutis, Bausch Health, Bristol-Myers Squibb, Cara, Castle, Dermavant, Galderma, LEO Pharma, Novartis, Vyne, acted as a consultant/advisory board attendee for Abbvie, Allergan, Almirall, Amgen, Arcutis, Bausch Health, Beiersdorf, BMS, Cara, Cutera, Dermavant, Eli Lilly, EPI, Galderma, Janssen, LEO Pharma, L’Oreal, Ortho, Pfizer, Sanofi-Regeneron, Sol-Gel, Swiss American, UCB, VisualDx, Vyne. Hilary Baldwin has acted as an investigator, consultant, and/or speaker for Almirall, Bausch Health, Cassiopea, EPI Health, Galderma, La Roche-Posay, L’Oreal, Mayne Pharma, Sol-Gel, Sun Pharma, and Vyne. Vincenzo Bettoli has acted as a consultant, advisory board member, research investigator and received honoraria from AbbVie, Beiersdorf, Bioderma, Biogena, Difa-Cooper, Galderma, Ganassini, GlaxoSmithKline, ICF, LEO Pharma, L’Oreal, Meda, Menarini-Relife, Mylan, Novartis, Pharcos-Biodue, UCB Pharma, and received research support (funds to institution) from AbbVie. James Del Rosso has acted as a research investigator, consultant and/or speaker for Almirall, Bausch Health (Ortho Dermatology), BiopharmX, EPI Health, Galderma, LEO Pharma, Mayne Pharma, Sol-Gel, Sonoma, Sun Pharma, and Vyne Therapeutics (Foamix). Thomas Dirschka has received grants/research support from Almirall, Biofrontera, Galderma, Meda, Schulze & BöhmGmbH, has lectured for Almirall, Biofrontera, Galderma, GlaxoSmithKline, Infectopharm, Janssen-Cilag, LEO Pharma, Meda, Neracare, Novartis, Riemser and is an advisory board member for Almirall, Biofrontera, Dr Pfleger, Galderma, GlaxoSmithKline, Janssen-Cilag, LEO Pharma, Meda, Neracare, Novartis, and Scibase. Brigitte Dréno has acted as investigator, consultant and/or speaker for Almirall, Avène, Bioderma, Fabre, Galderma, La RochePosay, L’Oreal, Novartis, and Sun Pharma. Linda Stein Gold has acted as an investigator/advisor and/or speaker for Almirall, Foamix, Galderma, Novartis, Ortho Derm, Sol-Gel, and Sun Pharma. Julie Harper has acted as a consultant for Almirall, BioPharmX, Cassiopea, Cutera, EPI, Foamix, Galderma, Ortho Derm, Sol-Gel, and Sun Pharma. Joo Yeon Ko has acted as a primary investigator for research (funded to institution) and/or received honoraria for unrestricted educational events from Amorepacific, Eli Lilly, and Galderma. Khaled Al Nuaimi has no relevant disclosures. Hazel H Oon has acted as a speaker, advisory board member and researcher for Galderma, a clinical investigator for Janssen, Novartis, and Pfizer and an advisory board member and speaker for AbbVie, Eli Lilly, and LEO Pharma. Murlidhar Rajagopalan has acted as a speaker and advisor for Galderma India, a consultant for Galderma and a speaker for Janssen, MSD, Novartis, Pfizer, Roche, and Sanofi. Marco Rocha has acted as an advisor, consultant, investigator and/or speaker and received grants/honoraria from Eucerin, FQMMelora, Galderma, Hypera, Johnson & Johnson, La Roche Posay, LEO Pharma, and Pierre-Fabre. Jo-Ann See has acted as an advisor, consultant, advisory board member and/or speaker for Allergan, Galderma, La Roche-Posay, LEO Pharma, L’Oreal, Mayne Pharma, and Viatris. Jonathan Weiss has acted as an investigator/advisor and/or speaker for Almirall, Dr Reddy’s, EPI Health, Foamix, Galderma, Novartis, and Ortho Derm. Jerry Tan has acted as an advisor, consultant, investigator and/or speaker and received grants/honoraria from Almirall, Bausch Health, Boots/Walgreens, Botanix, CeraVe, Cipher Pharmaceuticals, Cutera, Galderma, La Roche-Posay, Novan, Novartis, Pfizer, Promius, Sun Pharma, and Vichy., (© 2023 Published by Elsevier Inc. on behalf of the American Academy of Dermatology, Inc.)

Rats develop hyperalgesia and allodynia in the hind paw after L5 spinal nerve ligation. Phosphorylated extracellular regulated kinase (pERK) was used as a pain marker to investigate the potential role of adjacent uninjured L4 nerve in the development of heat hyperalgesia after L5 nerve injury. Left L5 nerve was ligated and sectioned in rats. Three days later, rats were randomly assigned to five groups; each had both hind paws immersed in water at different temperatures (no heat, 37, 42, 47, and 52 °C) under sevoflurane anesthesia for 2 minutes. Five minutes after stimulation the rats were sacrificed and sections of L3-L6 spinal segments were stained immunocytochemically with pERK antibody. pERK immunoreactivity, which is not detectable in the normal spinal cord, was discernible in neurons (not glia) of the superficial dorsal horn after noxious heat stimuli. pERK-positive neurons clearly overlapped in laminae I-II with normal unmyelinated and thin myelinated afferents labeled with calcitonin gene-related peptide and isolectin B4, and injured unmyelinated afferents labeled with vasoactive intestinal polypeptide. There was a linear increase in pERK immunoreactivity on both sides with an increase in temperature. Importantly, the number of positive pERK neurons was significantly higher in the ipsilateral side of L4 spinal segment, which receives innervation from uninjured L4 nerve, compared with the contralateral control side, which receives both uninjured L4 and L5 spinal nerves. The data demonstrate that the uninjured L4 nerve plays an important role in the development of heat hyperalgesia at the spinal cord level after L5 nerve injury., (© 2015 Wiley Periodicals, Inc.)

We present a novel approach to solve the cloud storage issues and provide a fast load balancing algorithm. Our approach is based on partitioning and concurrent dual direction download of the files from multiple cloud nodes. Partitions of the files are saved on the cloud rather than the full files, which provide a good optimization to the cloud storage usage. Only partial replication is used in this algorithm to ensure the reliability and availability of the data. Our focus is to improve the performance and optimize the storage usage by providing the DaaS on the cloud. This algorithm solves the problem of having to fully replicate large data sets, which uses up a lot of precious space on the cloud nodes. Reducing the space needed will help in reducing the cost of providing such space. Moreover, performance is also increased since multiple cloud servers will collaborate to provide the data to the cloud clients in a faster manner.