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BACKGROUND Dermatology consultations in the inpatient hospital setting can improve diagnostic accuracy and management. OBJECTIVE Characterize dermatologic diagnostic and treatment trends in the hospital setting and identify variables that may affect patient care. METHODS Retrospective chart review from 1 January 2012 to 31 December 2017 at Jackson Memorial Hospital (JMH) (Miami, Florida, USA), an academic non-profit tertiary care centre affiliated with University of Miami Miller School of Medicine, was performed. Patients who received dermatology consultations in the emergency department (ED) or inpatient settings were included. Patient demographics, admission information, provisional diagnosis and management plans by primary teams, final diagnosis, management plans and testing recommendations by the dermatology consults team, and follow-up information were collected. Analysis using Microsoft Excel of how time to consultation, admission length, inpatient versus ED setting and primary team affected diagnostic accuracy was also performed. RESULTS The 1004 consultations for 812 patients (n = 812) were reviewed (359 women, 453 men). Most patients were Hispanic (n = 359; 44.2%) or African American (n = 273; 33.6%). Mean admission length was 20.6 days (range 0-439; median 6). The most common consulting service was internal medicine (n = 452). In 387 cases (47.6%), primary teams did not give a provisional diagnosis. The most common provisional diagnoses were bacterial infection (n = 93), viral infection (n = 49) and drug reaction (n = 44). The most common diagnoses by dermatology were viral infection (n = 93), bacterial infection (n = 90) and drug reaction (n = 80). Dermatology consultation changed the provisional diagnosis in 55.7% of cases, more often in cases where consultation took place ≥2 days after admission (P

Cutaneous lupus erythematosus (CLE)—a common presentation of lupus erythematosus—may exist independently or as a part of the systemic manifestations of systemic lupus erythematosus. The effects of living with and treating a chronic condition such as CLE can be debilitating to a patient's health and finances. The management of patients with CLE is made particularly challenging by poor compliance, limited therapeutic options, scarcity of evidence supporting their use, and significant differences in costs of medications. Effective management of CLE should center on prevention, individualized treatment regimens, and a mutual understanding of the challenges that patients with CLE face. This article seeks to provide an overview of the efficacy, safety, and cost of therapeutic options for CLE.

Landslides are one of the most recurrent natural phenomena that are of overwhelming significance in the Himalayas. The Himalayan terrain being under severe transmutation by human interference and excess urban penetration has led to triggering of landslides along with causing colossal damage to property and loss of life. Immense risk looms large all along the Himalayas with cumulating conditions that build the potentiality to landslides. The study of landslides has drawn worldwide attention mainly due to the aggravating socio-economic consequences as well as the increasing pressure of urbanization on the mountain environment. In order to reduce the damage and manage vulnerable areas, there is imperative need to formulate comprehensive Landslide Vulnerability and Susceptibility Zonation maps for different areas of the Himalayan region emphasizing the urbanized and burgeoning pockets. The concept of landslide susceptibility and landslide susceptibility assessment have been introduced in the past couple of decades and various methodologies have been developed for evaluating the devastating power of landslides and its associated processes. The ultimate aim is to evolve a method suitable for specific areas through which appropriate management measures can be taken to reduce the risk from potential landslides. Any approach towards LSZ would require identification of the conditions leading to slope failure, their systematic mapping and evaluation of their relative contributions by amalgamation of all factors in the ultimatum. The aim of this paper is to assess the various landslide vulnerability factors in Nainital Municipality area on raster-based GIS platform and generate landslide vulnerability and susceptibility maps. To achieve the objective, a detailed inventory of maps based on all parameters assessed has been generated of the study area from the satellite imageries and field data. The accuracy of results is being validated by constant observation and prediction accuracies.

The isolated and identified bacteria from curd sample are of Lactobacillus sp. The bacteria of this spp. are lactic acid producers. These sp. resembles to Lactobacillus acidophilus. A probiotic is a microorganism known to be friendly and beneficial to its host when consumed. In today's time, probiotics are a very popular subject of research among scientists and pharmaceutical companies. Due to the over consumption of antibiotics, the normal micro flora of body does not survive. The spores obtained from pharmaceuticals are not good in taste, so generally children avoid eating them, hence we have made the probiotic chocolate. It is better to eat chocolate than medicine. The chocolate containing lyophilized Lactobacillus spp. may help directly for enhancing resistance against intestinal pathogens and in the prevention of diseases.

Background Leprosy reactions are immunologically mediated conditions and a major cause of disability before, during and after multidrug therapy. Little data has been published on the epidemiology of leprosy reactions in Bangladesh. Objectives To describe the pattern and prevalence of leprosy reactions in the post elimination stage. Methods A descriptive retrospective cross-sectional study was carried out in Chittagong Medical College Hospital using the registered records of patients the periods between 2004 and 2013. Results Of the 670 leprosy patients 488 (73.38%) were males and 182 (27.37%) were females. The prevalence of reaction was 300 (44.78%) with a male: female ratio of 3.55:1. The age specific cumulative reactions cases at >40 years was high 115 (38.33%) among all age groups. The prevalence of reaction was found to be 166 (55.33%) for the reversal reaction, 49 (16.57%) for the erythema nodosum leprosum and 85 (28.33%) for the neuritis. Borderline tuberculoid was the most common 106 (35.33%) group in reversal reaction while lepromatous leprosy was the most common 37 (12.33%) in erythema nodosum leprosum. More than half of the patients 169 (56.33%) had reactions at the time of presentations while 85 (28.33%) and 46 (15.33%) of patients developed reaction during and after multidrug therapy respectively. The reversal reaction group presented with ≥ 6 skin lesions in 96 (57.83%) and ≥ 2 nerves involvement in 107 (64.46%) patients. The erythema nodosum leprosum presented chiefly as papulo-nodular 45 (91.84%) lesions followed by pustule-necrotic 4 (8.16%) lesions, neuritis 33 (67.35%), fever 24 (48.98%), lymphadenitis 6 (12.24%), arthritis 5 (10.20%) and iritis 2 (4.08%). Bacterial index ≥ 3 had been demonstrated in 34 (60.71%) patients of erythema nodosum leprosum. Conclusion The incidence of leprosy reaction seemed to be more than three times common in borederline tuberculoid (52.33%) than in lepromatous leprosy (14%). Reactions with nerve function impairment and disability still occur among multibacillary patients during and after multidrug therapy. Early detection and management of leprosy reaction is very important in preventing disability and deformity, and patients should be educated to undergo regular follow-up examinations. Developing reinforced new therapies to curb leprosy reactions is crucial for improving leprosy health care services. This article is protected by copyright. All rights reserved.

Hidradenitis suppurativa is a member of the follicular occlusion tetrad, along with acne conglobata, dissecting cellulitis of the scalp and pilodinal sinus. These conditions share common pathophysiologic features, including follicle occlusion, bacterial overgrowth, severe suppurative inflammation, scarring, and sinus tract formation. Treatment of severe cases is challenging, and a novel treatment modality would be of significant value. We describe a 46-year-old man who presented with a 15-year history of suppurative and scarring nodules involving his groin, scalp, neck, face, and chest. Based on their distribution and morphology, these lesions were most characteristic of hidradenitis suppurativa, although he had features of acne conglobata and dissecting cellulitis as well. Over the years, he had been treated with several antimicrobial and immunomodulatory agents, the main conventional therapies for follicular occlusion syndromes, without much success. We then treated him with superficial brachytherapy to his right groin and occiput, which led to significant improvement. No toxic side effects were noted. This case demonstrates the successful application of superficial brachytherapy for the treatment of severe hidradenitis suppurativa, and possibly for other follicular occlusion syndromes.

Background The diagnosis of Lyme disease relies on the accurate diagnosis of erythema chronicum migrans (ECM) because serologic tests, culture, and polymerase chain reactions are often inaccurate. Although ECM is classically associated with a targetoid rash, there are many variants of this lesion. These variants of ECM are often initially diagnosed as cellulitis or spider bite reactions and treated with oral antibiotics. Inappropriate treatment further delays the diagnosis of Lyme disease, leading to late complications. Methods We present four cases of vesiculobullous and hemorrhagic ECM, a less common variant of ECM. Results All four patients had a history of exposure to wooded areas in Massachusetts during the summer months. In these patients, ECM presented with central vesicles and bullae with hemorrhage, crusting, and in some cases necrosis. Serologic testing was positive in three of the four cases at presentation. In one case, microscopic examination of a skin biopsy showed epidermal spongiosis with parakeratosis, focal necrosis, papillary dermal edema, erythrocyte extravasation, and a superficial and deep perivascular lymphocytic infiltrate with neutrophils and eosinophils of the dermis. No fungal organisms or bacteria were identified. All four patients were treated with doxycycline with complete resolution of symptoms. Conclusions It is important to recognize the vesiculobullous and hemorrhagic variants of ECM in order to minimize the provision of inappropriate antibiotic treatment for other diagnoses. Early diagnosis of ECM and the initiation of appropriate antibiotics may prevent late complications of Lyme disease.

Liquid injectable silicone (LIS) for cosmetic purposes has been widely available and commonly used for almost half a century. An increase in buttock augmentation procedures because of patients wanting to emulate the look of some celebrities has recently highlighted cases in the media of unsafe administration of liquid silicone injections. Severe complications including death have been reported. In this article, we report a case in which liquid silicone was injected in the patient's gluteal tissue resulting in granulomatous reactions in the surrounding tissues. The patient responded well to doxycycline, presumably because of both its antimicrobial properties and immunomodulatory effects.

AlGaN alloys find important applications in UV emitters and detectors, as well as in high-power high-frequency electronics. While reflection high energy electron diffraction (RHEED) is a standard technique for in situ monitoring of the growth of AlGaN alloys by plasma assisted molecular beam epitaxy, this paper investigates a new mode of its application. During the growth of AlGaN alloys, the ratio of the group III (Al + Ga) to group V (active nitrogen) adatoms critically controls the materials property of AlGaN films and is optimal within a very narrow window of operation. Moreover, this ratio is dependent in a complex fashion on various growth parameters, including substrate temperature, and is difficult to determine quantitatively in real time. This paper provides a method to estimate that important parameter. This can be carried out through the capture of the RHEED image from the fluorescent screen using an inexpensive video camera setup and a simple analysis procedure. While most RHEED analyses focus on the diffraction pattern, e.g., the line spacing, this work quantifies diffused scattering of the electron beam from a metallic layer that forms on the top of the growth surface during deposition under excess group III conditions, which is typically employed during growth. Two alternate methods for data analysis have been explored and compared. The results indicate that this process can qualitatively trace the variation of the thickness of the thin metallic layer, and hence the group III to group V flux ratio, for different substrate temperatures. This technique being simple, fast, and cost-effective can be incorporated into standard MBE systems for real-time in situ characterization of AlGaN alloys.

Hidradenitis suppurativa is a member of the follicular occlusion tetrad, along with acne conglobata, dissecting cellulitis of the scalp and pilodinal sinus. These conditions share common pathophysiologic features, including follicle occlusion, bacterial overgrowth, severe suppurative inflammation, scarring, and sinus tract formation. Treatment of severe cases is challenging, and a novel treatment modality would be of significant value. We describe a 46-year-old man who presented with a 15-year history of suppurative and scarring nodules involving his groin, scalp, neck, face, and chest. Based on their distribution and morphology, these lesions were most characteristic of hidradenitis suppurativa, although he had features of acne conglobata and dissecting cellulitis as well. Over the years, he had been treated with several antimicrobial and immunomodulatory agents, the main conventional therapies for follicular occlusion syndromes, without much success. We then treated him with superficial brachytherapy to his right groin and occiput, which led to significant improvement. No toxic side effects were noted. This case demonstrates the successful application of superficial brachytherapy for the treatment of severe hidradenitis suppurativa, and possibly for other follicular occlusion syndromes.

Background. Skin diseases associated with Human Immunodeficiency Virus (HIV) infection are associated with significant morbidity and mortality. In resource-limited settings, nondermatologists and lay health care providers on the front line of HIV care provide much of the treatment for these conditions.Objective. To evaluate guidelines for treatment of HIV-related skin conditions and assess their accessibility, comprehensiveness, and quality of evidence employed.Methods. A review was undertaken of all national and society guidelines which included treatment information on the ten highest burden HIV-related skin conditions. The search strategy included gray and peer-reviewed literature.Results. Of 430 potential guidelines, 86 met inclusion criteria, and only 2 were written specifically to address HIV-related skin diseases as a whole. Treatment information for HIV-related skin conditions was embedded within guidelines written for other purposes, primarily HIV/AIDs treatment guidelines (49%). Development of guidelines relied either partially or completely on expert opinion (62%). Only 16% of guidelines used gradation of evidence quality and these were primarily from high-income countries(p=0.001).Limitations. Due to the nature of gray literature, not all guidelines may have been identified.Conclusion. This review highlights the need for evidence-based summary guidelines that address treatment for HIV-related skin conditions in an accessible format.

Circulating tumour cells (CTCs) shed into blood from primary cancers include putative precursors that initiate distal metastases. Although these cells are extraordinarily rare, they may identify cellular pathways contributing to the blood-borne dissemination of cancer. Here, we adapted a microfluidic device for efficient capture of CTCs from an endogenous mouse pancreatic cancer model and subjected CTCs to single-molecule RNA sequencing, identifying Wnt2 as a candidate gene enriched in CTCs. Expression of WNT2 in pancreatic cancer cells suppresses anoikis, enhances anchorage-independent sphere formation, and increases metastatic propensity in vivo. This effect is correlated with fibronectin upregulation and suppressed by inhibition of MAP3K7 (also known as TAK1) kinase. In humans, formation of non-adherent tumour spheres by pancreatic cancer cells is associated with upregulation of multiple WNT genes, and pancreatic CTCs revealed enrichment for WNT signalling in 5 out of 11 cases. Thus, molecular analysis of CTCs may identify candidate therapeutic targets to prevent the distal spread of cancer.

Condylomata acuminata (CA), or anogenital warts, are typically benign lesions caused by human papillomavirus infection. Although they are rare, immunocompromised individuals are at a higher risk of CA undergoing transformation into invasive anal squamous cell carcinoma (SCC). These patients need aggressive evaluation and management. Treatment of CA is challenging, particularly for immunocompromised hosts, in whom warts are resistant to treatment and commonly recur. Currently, there is no gold standard treatment for CA, especially in children and immunodeficient individuals. We report the case of a 15-year-old immunocompromised girl with severe recalcitrant condyloma that resolved after a course of systemic 5-fluorouracil, mitomycin C, and radiation therapy for SCC.

Liquid injectable silicone (LIS) for cosmetic purposes has been widely available and commonly used for almost half a century. An increase in buttock augmentation procedures because of patients wanting to emulate the look of some celebrities has recently highlighted cases in the media of unsafe administration of liquid silicone injections. Severe complications including death have been reported. In this article, we report a case in which liquid silicone was injected in the patient's gluteal tissue resulting in granulomatous reactions in the surrounding tissues. The patient responded well to doxycycline, presumably because of both its antimicrobial properties and immunomodulatory effects.

Generating reliable expression profiles from minute cell quantities is critical for scientific discovery and potential clinical applications. Here we present low-quantity digital gene expression (LQ-DGE), an amplification-free approach involving capture of poly(A)(+) RNAs from cellular lysates onto poly(dT)-coated sequencing surfaces, followed by on-surface reverse transcription and sequencing. We applied LQ-DGE to profile malignant and nonmalignant mouse and human cells, demonstrating its quantitative power and potential applicability to archival specimens.

Corrigendum: RNA sequencing of pancreatic circulating tumour cells implicates WNT signalling in metastasis

Circulating tumor cells (CTCs) shed into blood from primary cancers include putative precursors that initiate distal metastases. While isolation and molecular analysis of these cells is technically challenging, they may identify cellular pathways that contribute to the blood-borne dissemination of cancer cells. Here, we adapted a microfluidic device for efficient capture of CTCs from an endogenous mouse pancreatic cancer model and subjected CTCs to digital gene expression (DGE) analysis using single molecule RNA sequencing. We identified Wnt2 as enriched in both CTCs and metastatic ascites cells, compared with primary tumors. Expression of Wnt2 in pancreatic cancer cells suppresses anoikis, enhances anchorage-independent sphere formation, and increases metastatic propensity in vivo. The effect of Wnt2 is correlated with fibronectin upregulation, and it is mediated in part through non-canonical Wnt signaling and suppressed by inhibition of the Map3k7 (Tak1) kinase, an integrator of Wnt, BMP and TGF-β signaling. DGE analysis of human pancreatic CTCs reveals significant enrichment for non-canonical Wnt signaling in 5 of 11 cases, with Wnt2 RNA detectable by in situ hybridization in a subset of CTCs. Identifying CTC-enriched transcripts such as Wnt2 may point to pathways that enhance haematogenous metastasis, thus providing novel therapeutic targets to prevent the distal spread of cancer. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 5304. doi:1538-7445.AM2012-5304