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Introduction: Neurology wait times - from referral to consultation - continue to grow, leading to various adverse effects on patient outcomes. Key elements of virtual care can be leveraged to improve efficiency. This study examines the implementation of a novel virtual care model - Virtual Rapid Access Clinics - at the Neurology Centre of Toronto. The model employs a patient-centred care workflow, involving multidisciplinary staff and online administrative tools that are synthesized to expedite care and maintain quality., Methods: Virtual Rapid Access Clinic efficacy was studied by determining average wait times and patient throughput, calculated from anonymous data that was extracted from the clinic patient database (n  =  1542). Comparative analysis focused on new patient consultations during the 12-month periods prior to (pre-Virtual Rapid Access Clinic, n  =  456) and following (post-Virtual Rapid Access Clinic, n  =  1086) Virtual Rapid Access Clinic implementation., Results: After Virtual Rapid Access Clinic implementation, there was a mean 15-day wait time reduction, and a monthly average 52-patient increase in patient throughput. Wait time reductions and increased patient throughput were observed in all three Virtual Rapid Access Clinic sub-clinics - epilepsy, headache and concussion. Respectively, average wait times reduced significantly by 26.4 and 18.9 days and insignificantly by 1.1 days; monthly average patient throughputs increased by 235%, 95% and 161%., Discussion: These findings demonstrated that the Virtual Rapid Access Clinic model of care is effective at reducing patient wait times and increasing patient throughput. While the Virtual Rapid Access Clinic presents a feasible model both during and after pandemic restrictions, further research exploring its scalability in other care contexts, potential changes in care quality and efficiency outside of pandemic restrictions must be performed., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: A small body of evidence suggests medical cannabis may facilitate wound healing, but the exact mechanism of this effect is unclear., Purpose: This case report describes a patient with a pressure injury (PI) who received cannabis oil treatment for pain management and sleep improvement., Methods: A 37-year-old woman with multiminicore disease, scoliosis, short-chain acyl-CoA dehydrogenase deficiency, and epilepsy presented to the Neurology Centre of Toronto with chronic pain and sleep disturbance, including difficulty initiating and maintaining sleep. She also had a 5-year history of a PI between her right iliac crest and right rib cage that had progressively worsened. The patient received a medical cannabis oil protocol that used a combination of cannabidiol and tetrahydrocannabinol., Results: Cannabis oil was effective in treating pain and sleep difficulties. Unexpectedly, during the first 2 weeks of treatment, the PI started to heal and was almost completely closed at the 2-month follow-up., Conclusion: Although it is unknown if the observed healing of this refractory PI was indirectly or directly related to the cannabidiol and tetrahydrocannabinol treatment, the potential relationships among pain, sleep disturbance, cannabis treatment, and healing should be explored.

Background: Intense pulsed light therapy (IPL) decreases facial erythema and telangiectasias associated with rosacea. Topical skin care products decrease facial erythema by the action of active ingredients and masking effects., Objectives: To assess the efficacy and tolerability of combining a topical skin care regimen (TSCR) comprised of a multifunctional three-in-one facial cream and a mineral-based brush-on SPF50 powder sunscreen with a single IPL treatment for treating mild-to-severe facial redness associated with rosacea., Methods: Twenty female subjects with Fitzpatrick skin types I-III received TSCR monotherapy for 12 weeks. At that time, subjects received a single IPL treatment and continued TSCR for 6 additional weeks. Subjects were evaluated at Baseline and at Weeks 4, 8, 12, and 18., Results: Using a 7-point redness scale, the overall mean (SD) redness score significantly improved from 3.05 (0.97) at baseline to 2.05 (0.76) at Week 18 (P < 0.01). There was a decrease in investigator-rated erythema from baseline (bare skin) to Week 12 (bare skin, before IPL) when TSCR was used as monotherapy which did not achieve significance (P = 0.12). Most subjects (80%) were satisfied or Very satisfied with the TSCR at Week 18. All subjects (100%) agreed that it improved their baseline skin redness and most (85%) would recommend TSCR to others. TSCR was well-tolerated with no significant changes in skin dryness, scaling, or itching. Mild burning occurred immediately following the IPL treatment at Week 12., Conclusion: TSCR in combination with a single IPL treatment produced a significant improvement in overall facial redness in patients with rosacea. Longer-term treatment with TSCR may produce continued improvement., (© 2019 Wiley Periodicals, Inc.)

Background: A number of epidermal and papillary dermal skin conditions can be treated safely and effectively with fractional photothermolysis (FP)., Objective: We sought to evaluate the effectiveness of FP with a 1550-nm fractionated erbium-doped fiber laser for the treatment of facial actinic keratoses (AKs)., Methods: Fourteen men, ages 59 to 79 years, underwent 5 laser treatments (2- to 4-week intervals) at an energy fluence of 20 to 70 mJ and treatment level of 11 (8-10 passes), corresponding to 32% to 40% surface area coverage. AK counts and photographs were taken at baseline, before each treatment, and at 1-, 3-, and 6-month follow-ups after the last treatment. Biopsies were performed at baseline and at the 3-month follow-up. The clinical improvement of the actinic lesions was evaluated by a dermatologist using digital photography and lesion counts at all 3 follow-up visits., Results: The AK count for each patient was reduced on average by 73.1% (67.5%-77.7%) at the 1-month, 66.2% (60.0%-71.5%) at the 3-month, and 55.6% (43.9%-64.8%) at the 6-month follow-up visit. Excluding two cases, all biopsy specimens (baseline and at the 3-month follow-up) were positive for histologic features of AK and/or squamous cell carcinoma., Limitations: This study is limited by a small number of patients; therefore further clinical studies are warranted., Conclusions: FP decreases the number of clinical AKs; however, posttreatment biopsy specimens indicate the histologic persistence of AKs (epidermal tumors). FP is not an adequate single-treatment modality for AKs., (Copyright © 2011 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.)

Background: Melasma on the face is difficult to treat and is often refractory to multiple treatment modalities., Objectives: To investigate the safety and efficacy of fractional photothermolysis (FP) for the treatment of melasma and to determine recurrence rates with this treatment method., Materials and Methods: Eight female patients (Fitzpatrick skin type II-IV) with clinically diagnosed melasma on the face were treated using FP (1,550 nm Fraxel SR laser). Two to seven treatments were performed at 3- to 8-week intervals. Treatment levels ranged from 3 to 10, corresponding to 9% to 29% surface area coverage (8-10 passes per treatment). Energies used ranged from 6 to 40 mJ. Physician and patient assessments were recorded at each visit and at a follow-up visit 7 to 36 months (mean 13.5 months) after the last treatment session., Results: At the last treatment, assessments revealed greater than 50% clinical improvement in melasma in five of eight patients. Follow-up assessments by the evaluating physician revealed sustained efficacy in five patients. Recurrence was reported in three patients. No significant adverse effects were noted., Conclusions: FP is a safe and effective treatment for refractory melasma, with long-term remission.

Background: Nonablative fractional photothermolysis has revolutionized the way we treat a number of common skin conditions with laser technology., Objective: A comprehensive guide is needed for clinicians using this technology to treat specific skin conditions in various skin types., Materials and Methods: Recommendations were made from a recent round table discussion among experienced physicians and a review of recent literature findings., Results: Optimal laser parameters are dependent on patient skin type and condition. We recommended guidelines for the successful treatment of several common skin conditions on and off the face using nonablative fractional photothermolysis. Specific conditions were dyschromia, rhytides, acne scars, surgical scars, melasma, and striae distensae., Conclusions: We developed reproducible guidelines to most effectively treat a variety of skin types and conditions using nonablative fractional photothermolysis. Future large, multicenter trials are indicated for further optimization of treatment parameters.

Background: Desmoplastic trichoepithelioma (DTE) is an uncommon adnexal tumor usually found on the face of young women., Objective: We sought to describe the clinical and histologic characteristics of DTE and discuss management strategies for these tumors., Methods: We conducted a retrospective case series and review of the literature., Results: A series of 17 cases of DTE is reported. Of our patients, 82% were female and half of all these cases occurred on the cheek. Unlike previous reports, the patients in our study were slightly older, with 53% older than 51 years and 71% between the ages of 31 and 60 years at the time of surgery (mean age 49 years, median age 52 years, range 14-81 years). Approximately 38% of the tumors had been present for 1 to 2 years before presentation. The average size of the tumors at the time of surgery was 0.8 x 0.6 cm. All cases were treated with Mohs micrographic surgery. To date, none of the tumors have recurred., Limitations: This is a small case series. The referral patterns of our predominantly Mohs micrographic surgery clinic might further bias this study., Conclusion: DTE is a benign tumor that has a predilection for the face. With its rapid growth, aggressive histologic features that may be confused with basal cell carcinoma, and tendency to arise in cosmetically and functionally sensitive areas, these tumors should be removed in a manner that assures clear surgical margins, such as Mohs micrographic surgery.

Arthropod bites remain a major cause of patient morbidity. These bites can cause local or systemic effects that may be infectious or inflammatory in nature. Arthropods, notably insects and arachnids, are vectors of potentially serious ailments including malaria, West Nile virus, dengue, and Lyme disease. Measures to curtail the impact of insect bites are important in the worldwide public health effort to safely protect patients and prevent the spread of disease. The history of insect repellent (IR) lends insight into some of the current scientific strategies behind newer products. Active ingredients of currently available IRs include N,N-diethyl-3-methylbenzamide (DEET), botanicals, citronella, and, the newest agent, picaridin. Currently, the Environmental Protection Agency's registered IR ingredients approved for application to the skin include DEET, picaridin, MGK-326, MGK-264, IR3535, oil of citronella, and oil of lemon eucalyptus. DEET has reigned as the most efficacious and broadly used IR for the last 6 decades, with a strong safety record and excellent protection against ticks, mosquitoes, and other arthropods. Newer agents, like picaridin and natural products such as oil of lemon eucalyptus are becoming increasingly popular because of their low toxicity, comparable efficacy, and customer approval. Various characteristics and individual product advantages may lead physicians to recommend one agent over another.

Objectives: The objective of this narrative review is to explore the advantages and limitations of VHs in delivering healthcare, including access to specialized professionals, streamlined communication, efficient scheduling, integration of electronic health records, ongoing monitoring, and support, transcending geographical boundaries, and resource optimization. Methods: Review of literature. Results: The national healthcare systems are facing an alarming rise in pressure due to global shifts. Virtual hospitals (VH) offer a practical solution to numerous systemic challenges, including rising costs and increased workloads for healthcare providers. VH also facilitate the delivery of personalized services and enable the monitoring of patients beyond the conventional confines of healthcare settings, reducing the reliance on waiting medicine carried out in doctors' offices or hospitals. Conclusion: VH can mirror the conventional healthcare referral system. [ABSTRACT FROM AUTHOR]

Background/aim: Strengthening the muscles of the lumbar region in individuals with neck pain may be protective against future back problems. In addition, telerehabilitation applications, which gained momentum in the literature and clinical practice during the COVID-19 pandemic, are among the applications preferred by patients thanks to their various advantages. This study aimed to compare the effects of telerehabilitation and spinal stabilization exercises applied with face-to-face approaches on the thickness of the transversus abdominis (M.TrA) and lumbar multifidus (M.LM) muscles in patients with nonspecific neck pain. Materials and methods: The primary outcomes were the thickness of the M.TrA and M.LM. Neck pain intensity and neck disability were secondary outcomes. Muscle thickness was evaluated with an ultrasound device, neck pain intensity was assessed with a visual analog scale, and disability was assessed with the Neck Disability Index. Patients were randomly assigned to the telerehabilitation group (TRG) (n = 13) or the control group (CG) (n = 13). While the TRG did the exercises with live videos and video recordings, the CG did exercises face-to-face in the clinic. Both groups performed the same exercises for 45 minutes per session 3 days a week for 8 weeks. Results: At the end of the treatment, the thicknesses of the M.TrA and M.LM were increased and neck pain intensity and neck disability were decreased in both groups (p < 0.05). The groups were similar in terms of these variables (p > 0.05). Conclusion: Telerehabilitation and face-to-face spinal stabilization exercises are both beneficial for spinal muscle architecture and clinical variables as a preventive measure against future lower back problems in individuals with neck pain. [ABSTRACT FROM AUTHOR]

Background: There has been no previously published study on skin cancers on the scalp of women., Objectives: To better elucidate the characteristics of skin cancers that develop on the female scalp., Methods: A retrospective review of 13,885 biopsy-proven skin cancers treated by Mohs micrographic surgery was performed. We identified 197 tumors on the scalp of women. Demographic features and tumor characteristics were compiled and analyzed., Results: The average age of women with scalp tumors was 61.8 +/- 16.9, which was significantly lower than that of men with scalp tumors. The age followed a bimodal distribution with peaks in the fifth and eighth decades. Overall, 77% of female scalp tumors were basal cell carcinomas (BCCs), 17% were squamous cell carcinomas (SCCs), and 6% were a variety of other tumors. This contrasts with men in whom 53% of tumors were squamous cell carcinomas. Basal cell carcinomas were significantly more common in women under age 50., Conclusion: Skin cancers of the female scalp tend to be basal cell carcinomas, many of which occur at a relatively young age as compared to other skin cancers. The exact role of ultraviolet radiation in the development of some of these tumors is unclear.

Dermatosis papulosa nigra (DPN) is a variant of seborrheic keratosis that typically presents as hyperpigmented pedunculated papules on the face, trunk, and/or back in those with skin of color. Although benign, the lesions can cause significant discomfort and distress. Management options are limited and often unaffordable, as treatment is elective in most cases. This study was undertaken to provide an updated summary of safe and efficacious treatments for DPN. Five databases were searched to identify full-text publications reporting on treatments and outcomes in adults with DPN. Seventeen publications met inclusion criteria and were included: six cohort studies, one randomized controlled trial, five case report studies, one case series, and four pilot studies. Treatment options included simple excision, curettage, electrodesiccation, cryotherapy, topicals, and laser therapies. These modalities varied in their documented outcomes and associated potential adverse effect profiles. Postinflammatory hyperpigmentation is a common adverse effect that often leads to patient dissatisfaction. It can be mitigated with topical treatments aimed at reducing local inflammation. Study limitations included small sample size in individual studies, lack of consistent reporting of Fitzpatrick skin type, and lack of comparison to the standard treatment of electrodesiccation or curettage. Ultimately, treatment should consider the patient's Fitzpatrick type, treatment area, associated costs, and potential adverse effects., (© 2024 the International Society of Dermatology.)

Pathogens transmitted by mosquitoes threaten human health around the globe. The use of effective mosquito repellents can protect individuals from contracting mosquito-borne diseases. Collecting evidence to confirm and quantify the effectiveness of a mosquito repellent is crucial and requires thorough standardized testing. There are multitudes of methods to test repellents that each have their own strengths and weaknesses. Determining which type of test to conduct can be challenging and the collection of currently used and standardized methods has changed over time. Some of these methods can be powerful to rapidly screen numerous putative repellent treatments. Other methods can test mosquito responses to specific treatments and measure either spatial or contact repellency. A subset of these methods uses live animals or human volunteers to test the repellency of treatments. Assays can greatly vary in their affordability and accessibility for researchers and/or may require additional methods to confirm results. Here I present a critical review that covers some of the most frequently used laboratory assays from the last two decades. I discuss the experimental designs and highlight some of the strengths and weaknesses of each type of method covered. [ABSTRACT FROM AUTHOR]

Background: The development of economically viable and environmentally neutral tools to control insects that consume or damage over 20% of global agriculture or vector human and animal disease represents one of the most important challenges of the 21st century. The suite of chemical-based strategies currently employed to control insect populations rely primarily on insecticides, which are subject to rapid resistance and often have harmful off-target environmental and health-related impacts, and, to a lesser degree, repellents, which typically rely on masking attractive odors. The discovery and characterization of Vanderbilt University allosteric agonists (VUAAs), a family of small-molecule agonists that target the highly conserved, insect-specific odorant receptor coreceptor (Orco), raise the potential for the development of a novel repellent paradigm for vector/pest management. VUAAs have the potential to target nearly all insect olfactory sensory neurons, leading to highly aversive behavioral responses, but importantly have limited volatility, thereby reducing their utility as spatial repellents., Results: We have characterized VUAA thermolysis components and identified a suite of volatiles (VUAA-based active ingredients, VUAIs) that act specifically in novel binary combinations as robust and long-lasting spatial repellents against Anopheline mosquitoes. In mobility-based behavioral experiments, VUAIs act synergistically as effective spatial repellents and outperform parent VUAA compounds against host-seeking Anopheline mosquitoes., Conclusions: VUAIs are volatile alternatives to Vanderbilt University allosteric agonists (VUAAs) that have the potential for use as spatial repellents in disease vector and agricultural pest control. The repellency observed is odorant receptor coreceptor (Orco)-dependent, supporting the hypothesis that VUAIs and VUAAs similarly target an allosteric Orco recognition site. © 2024 The Author(s). Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry., (© 2024 The Author(s). Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.)

Background: Ablative carbon dioxide (CO2) laser is still a cornerstone in the management of xanthelasma. However, post‐laser complications such as post‐inflammatory hyperpigmentation or scarring have to be considered. Heparin sodium was recently suggested as an effective therapeutic modality for xanthelasma. Objective: The aim of this work was to compare the therapeutic value of ablative CO2 laser versus intradermal heparin sodium in xanthelasma. Methods: This study was piloted on 30 xanthelasma patients, whose lesions were randomly categorized into two groups. Group A was managed with CO2 laser ablation (2 sessions scheduled every 4 weeks), whereas Group B was managed with intradermal heparin sodium injections (10 sessions scheduled every week). Pre‐ and post‐treatments evaluations were done both clinically and dermoscopically. Results: Significant reduction of xanthelasma lesions was reported in response to both therapeutic interventions. However, the ablative CO2 laser was more significantly effective than intradermal heparin sodium. Interestingly, intradermal injection of heparin sodium was nearly as effective as ablative CO2 laser in early (<2 years duration) grade I and II xanthelasma, with a lower incidence of post‐therapy side effects. Conclusions: Intradermal injection of heparin sodium could be suggested as a safe and cost‐effective therapeutic technique for early mild grade I and II xanthelasma. Moreover, it could be recommended as a pre‐operative management of grade III and IV xanthelasma to reduce the lesions to be easily ablated with CO2 laser. [ABSTRACT FROM AUTHOR]

N,N-diethyl-meta-toluamide (DEET) is a widely used insect repellent, with minimal skin permeation and sustained repellent activity in the superficial layers of the skin. In this study, we prepared a 10% DEET formulation consisting of 40% ethanol with or without 2% poly(oxyethylene)/poly(oxypropylene) butyl ether (POE-POP), an amphiphilic random copolymer. Further, we demonstrated the effects of POE-POP on tensile stress (stickiness), hydrophobicity, skin retention, permeation, and repellent activity of DEET. Stickiness was measured in male ICR mice (7-week old), and skin retention and permeation were evaluated in male Wistar rats (7-week old). In addition, female Aedes albopictus were used to measure the repellent action of DEET. The addition of POE-POP did not affect stickiness, volatility, and degradability but decreased logP and increased viscosity of DEET. Next, we demonstrated the behavior of DEET formulations in the rat skin. POE-POP prolonged the retention of DEET in the superficial layers of the rat skin (skin surface and stratum corneum) and decreased the penetration of DEET into rat skin tissues (epithelium and dermis). The repellent effect of DEET was also enhanced by the addition of POE-POP. However, severe skin damage was not observed after repetitive treatment with DEET formulations containing POE-POP for one month (twice a day). In conclusion, we demonstrated that a 10% DEET formulation consisting of 40% ethanol and 2% POE-POP attenuated the skin penetration and prolonged the repellent action of DEET without causing stickiness and skin damage. We conclude that the combination of ethanol and POE-POP is useful as a safe and effective delivery system for the development of insect repellent formulations containing DEET. [ABSTRACT FROM AUTHOR]

Background: The appearance of skin scars is known as one of the main side effects of skin burns. Stromal vascular fraction (SVF), as a rich source of cell populations with tissue regeneration properties, plays an important role in the healing of skin lesions. Fractional CO2 lasers have occupied a special place in treating skin lesions, particularly skin scars, since their introduction. Our study aimed to compare the combination of SVF and fractional CO2 laser with fractional CO2 laser alone in the treatment of burn scars. Method: This double-blind clinical trial study was conducted on ten patients with burn scars that were treated three times with a fractional CO2 laser at site of burn lesions, and one of the two areas studied was randomly injected with SVF. Two months after completion of the procedure, patients' scars were assessed using the Vancouver scar scale (VSS), biometric criteria, and physician and patient satisfaction ratings. Results: The results confirmed a significant improvement in VSS, cutometry, R7 criteria, complete density sonography, and skin density sonography in the fractional CO2 laser-treated group. The VSS criteria, epidermal thickness sonography, complete density sonography, and skin density sonography in the group treated with the combination of fractional CO2 laser and SVF also showed significant improvement. The VSS criteria and melanin index of Mexameter in the group treated with SVF in combination with fractional CO2 laser were significantly better than the group treated with fractional CO2 laser alone. Also, physician and patient satisfaction in the group treated with SVF injection in combination with fractional CO2 laser was significantly higher than the other group. Conclusion: The results confirm the efficacy of SVF injection in combination with fractional CO2 laser in the treatment of burn scars and can be considered as a treatment option for better management of these lesions. Trial registration: The study protocol was retrospectively registered at Iranian Registry of Clinical Trials with code: IRCT20210515051307N1, Registration date: 2021-11-14, URL: https://www.irct.ir/trial/56337. [ABSTRACT FROM AUTHOR]

Purpose of Review: The purpose of the study is to review and discuss the use of telemedicine in headache medicine. Recent Findings: Before the COVID-19 pandemic, the use of telemedicine for headache was most common in Europe. In recent years, however, telemedicine has been used broadly within headache medicine, including for pediatric patients and behavioral interventions. Several randomized clinical trials have shown that telemedicine is non-inferior to face-to-face visits. Multiple studies have reported substantial benefits associated with telemedicine, including high satisfaction rates, improved access to headache specialists, reduced travel, quicker visits, greater cost-effectiveness, reduced wait times, reduced no-show rates, and the increased comfort of remaining in one's home environment. The main limitation reported is the lack of a physical examination, including fundus assessment. Summary: Telemedicine has become a vital tool in headache patient care, with the data supporting its use for patient follow-up in particular. [ABSTRACT FROM AUTHOR]

From October 1981 to September 1984, the authors conducted a three-year longitudinal study of diarrhea among infants and toddlers attending day care centers in Maricopa County, Arizona. In the third year of study, they evaluated the effects on diarrhea rates of staff training without external monitoring and of active surveillance conducted throughout the study. From 21 study day care centers, they randomly selected 10 ("intervention day care centers") to receive staff training in procedures to reduce transmission of infectious diarrhea. Continuing active surveillance in the 10 intervention and 11 control day care centers found no difference between diarrhea rates in intervention day care centers in the pre- and posttraining years and no difference between diarrhea rates in the two groups of centers either before or after the training intervention. Biweekly family-based surveys during the two months after training also demonstrated no difference between infant-toddler diarrhea rates in intervention and control day care centers. These surveys found the 21 study day care centers to have significantly higher diarrhea rates than did day care homes or households not using day care, but significantly lower rates than day care centers not included in the active surveillance. Continuous surveillance without training was associated with a significant decrease in diarrheal illness during the course of longitudinal study. One-time staff training without subsequent monitoring did not result in additional decreases and did not lower day care center diarrhea rates to the levels observed in day care homes and households not using day care.

Striae gravidarum (SG) is a common pregnancy-related dermatologic problem, for which finding an effective treatment remains a challenge. To evaluate the safety and efficacy of 1540 nm non-ablative fractional laser (Star lux 500) in the treatment of SG in Iranian women and peruse the relationship between clinical improvement rate and patient characteristics as well as clinical features of striae. A prospective before-after study was conducted on 50 patients with SG who received three monthly sessions of 1540 nm non-ablative fractional laser and were followed for 2 months after the last treatment session. Clinical changes were measured using both provider-rated outcome through before/after pictures represented by final clinical score (from 0 to 5) and patient-reported outcome (patient global assessment or PGA). Over the course of the study both final clinical score and PGA increased significantly from week 4 to week 20 (P value: <0.001 and 0.048, respectively). Only modest adverse effects including erythema, edema and hyperpigmentation were noted. In conclusion, patients with SG of different type (rubra/alba) or maturity may somehow benefit from treatment with NAFL experiencing minimal transient side effects. Therefore, NAFL may be considered a safe and partially effective treatment option for stretch mark of patients with SG. [ABSTRACT FROM AUTHOR]

Background: Acanthosis nigricans (AN) is a common chronic skin disorder clinically presents by velvety hyperpigmented lesions mainly at the flexural areas. Fractional photothermolysis has been reported to improve both pigmentary and textural changes by removing thin layers of skin with minimal thermal damage. Other options are the Q-switched (Qs) Nd:YAG (1064 nm) and Qs KTP (532 nm) lasers. Both can induce collagen remodeling by dermal photo-mechanical microdamage. Aim of the Work: The aim of this study was to assess the clinical efficacy and the safety of fractional CO2 laser versus Qs Nd:YAG and KTP lasers in the treatment of acanthosis nigricans. Methods: This randomized-controlled split neck study was conducted on 23 patients suffering from AN. For each patient, one side of the neck was randomly assigned to fractional CO2 laser and the other side to Qs Nd:YAG and KTP lasers every four weeks for four months followed by 4 monthly follow-up assessment. Acanthosis Nigricans Area and Severity Index (ANASI) score, melanin and erythema indices as well as Patient Satisfaction Scale (PSS) were used to assess improvement on each side separately. Results: There was no statistically significant difference regarding the clinical improvement between the side treated with Fractional CO2 laser and the side treated with Qs Nd:YAG and KTP lasers (P value > 0.05). In most patients, both sides showed improvement during different sessions of therapy, as regards ANASI scores, melanin indices, patient satisfaction scores, and side effects. Conclusion: In this study, we concluded that both fractional CO2 and Q-switched lasers proved to be a safe and effective line of treatment of acanthosis nigricans. [ABSTRACT FROM AUTHOR]

N, N-diethyl-meta-toluamide (DEET) has been considered the 'gold standard' for insect repellent use since the 1950s and constitutes most insect repellents on the market. However, conflicting data in the scientific literature and confusing information in the media are at the core of debates about the safety of DEET insect repellents for the protection of children against arthropod bites. The few fatal occurrences involving DEET insect repellents and complications of their use in the pediatric population are typically the result of accidental overdoses or misuse of insect repellents that disregard warnings on product labels. With appropriate application, the safety record of DEET insect repellents continues to be excellent with few side effects. The purpose of this review is to provide a summary of the literature on safety outcomes of DEET insect repellent use in children; outline the pediatric recommendations relating to DEET insect repellents; and provide an overview of EPA-approved and naturally derived alternatives to DEET that possess low toxicity while providing a similar level of protection to synthetic insect repellents., (© 2024 Wiley Periodicals LLC.)

Background: The bites and blood sucking of bed bugs (Cimex spp.) (Hemiptera: Cimicidae) pose a serious threat to human physical and mental health. Application of an effective repellent can prevent or reduce bed bug bites. Previous studies on repellent screening mainly focused on Cimex lectularius L. In this study, we investigated the repellent effect of two safe food additives, ethyl anthranilate (EA) and butyl anthranilate (BA), against Cimex hemipterus (F.), and also explored the role of antennae and mouthparts on C. hemipterus perception of repellents., Results: Both EA and BA had a strong repellent effect against tropical bed bugs and their repellency was similar or lower than that of N,N-diethyl-3-methyl benzoyl amide, depending on whether or not a CO 2 source was present. EA had higher repellency than BA and exhibited repellency to C. hemipterus for 3 days when a CO 2 source was present. C. hemipterus avoided resting on 20% EA- and BA-treated harborages. Applying 20% EA and BA on rabbit skin significantly reduced the blood intake of C. hemipterus within 2 h. C. hemipterus could perceive EA and BA after their antennae or mouthparts or both antennae and mouthparts were removed., Conclusion: Both EA and BA had strong repellency against C. hemipterus, with EA being more repellent. Ablation of antennae and mouthparts did not affect the perception of EA and BA by C. hemipterus. © 2023 Society of Chemical Industry., (© 2023 Society of Chemical Industry.)

Introduction: Benign fibroproliferative scars that are larger than the initial lesion are called keloids. Keloids treatment in clinical practice is still difficult. Although there are various therapy choices, none is embraced by everyone or is relapse-free. Various treatment modalities such as intralesional corticosteroid injection with 5-fluorouracil (5-FU), fractional Er:YAG laser, pulsed dye laser (PDL), and others can be used either as monotherapies or combined therapies. Therefore, efforts should be made to select the treatment that will provide the best results. Case Presentation: A 6-year-old boy with keloids on the lower lips extending to the chin was successfully treated with a 2940-nm fractional Er:YAG laser alternated with a 595-nm long-PDL followed by the combined intralesional injection of corticosteroid and 5-FU. The patient was followed up for 1 year with no lesion recurrence. Conclusion: Our case supports a combined therapy to successfully treat a patient with a keloid on the chin. Therapy using a combination of these four modalities seems safe and effective and may have a synergistic effect with minimal downtime. [ABSTRACT FROM AUTHOR]

Dengue, yellow fever, Chinkungunya, Zika virus, and West Nile fever have infected millions and killed a considerable number of humans since their emergence. These arboviruses are transmitted by mosquito bites and topical chemical repellents are the most commonly used method to protect against vector arthropod species. This study aimed to develop a new generation of repellent formulations to promote improved arboviruses transmission control. A repellent system based on polycaprolactone (PCL)-polymeric nanoparticles was developed for the dual encapsulation of IR3535 and geraniol and further incorporation into a thermosensitive hydrogel. The physicochemical and morphological parameters of the prepared formulations were evaluated by dynamic light scattering (DLS), nano tracking analysis (NTA), atomic force microscopy (AFM). In vitro release mechanisms and permeation performance were evaluated before and after nanoparticles incorporation into the hydrogels. FTIR analysis was performed to evaluate the effect of formulation epidermal contact. Potential cytotoxicity was evaluated using the MTT reduction test and disc diffusion methods. The nanoparticle formulations were stable over 120 days with encapsulation efficiency (EE) of 60% and 99% for IR3535 and geraniol, respectively. AFM analysis revealed a spherical nanoparticle morphology. After 24 h, 7 ± 0.1% and 83 ± 2% of the GRL and IR3535, respectively, were released while the same formulation incorporated in poloxamer 407 hydrogel released 11 ± 0.9% and 29 ± 3% of the loaded GRL and IR3535, respectively. GRL permeation from PCL nanoparticles and PCL nanoparticles in the hydrogel showed similar profiles, while IR3535 permeation was modulated by formulation compositions. Differences in IR3535 permeated amounts were higher for PCL nanoparticles in the hydrogels (36.9 ± 1.1 mg/cm2) compared to the IR3535-PCL nanoparticles (29.2 ± 1.5 mg/cm2). However, both active permeation concentrations were low at 24 h, indicating that the formulations (PCL nanoparticles and PCL in hydrogel) controlled the bioactive percutaneous absorption. Minor changes in the stratum corneum (SC) caused by interaction with the formulations may not represent a consumer safety risk. The cytotoxicity results presented herein indicate the carrier systems based on poly-epsilon caprolactone (PCL) exhibited a reduced toxic effect when compared to emulsions, opening perspectives for these systems to be used as a tool to prolong protection times with lower active repellent concentrations. [ABSTRACT FROM AUTHOR]

Melasma is an acquired hyperpigmentation disease characterized by hyperpigmented patches in sun‐exposed areas that significantly impairs life quality. Topical treatments such as hydroquinone, retinoic acid, azelaic acid, chemical peels and laser treatments are among the main treatment options. In our study, we aimed to compare the effectiveness of Jessner peeling and 1064 nm Q‐switched Nd:YAG laser in melasma treatment. For this purpose, Jessner peeling was applied to 20 patients and 1064 nm Q‐switched Nd: YAG laser was applied to 19 patients of 39 melasma patients who applied to the cosmetology unit of Ege University department of dermatology and venereal diseases between November 2018–March 2020. Thirty seven patients completed the study. Changes in MASI, pigment and erythema scores measured by mexameter before and after treatment were compared for two groups. A statistically significant decrease in MASI scores, pigment and erythema scores was observed in both groups with no significant difference between two groups. In conclusion, in our study, it has been shown that Jessner peeling and 1064 nm Q‐switched Nd:YAG laser are equally effective in treatment of melasma. [ABSTRACT FROM AUTHOR]

Repellents serve an important role in bite protection. Tick repellents largely rely on biomechanisms that induce responses with direct contact, but synthetic pyrethroids used as spatial repellents against insects have received recent attention for potential use in tick protection systems. An in vitro vertical climb assay was designed to assess spatial repellency against Dermacentor variabilis, Amblyomma americanum, and Ixodes scapularis adult, female ticks. Climbing behavior was assessed with and without the presence of two spatial repellents, transfluthrin and metofluthrin. Repellency parameters were defined to simulate the natural questing behavior of ambushing ticks, including measures of detachment, pseudo-questing duration, climbing deterrence, and activity. Significant effects were observed within each parameter. D. variabilis showed the greatest general susceptibility to each repellent, followed by A. americanum, and I. scapularis. The most important and integrative measure of repellency was climbing deterrence–a measure of the spatial repellent's ability to disrupt a tick's natural propensity to climb. Transfluthrin deterred 75% of D. variabilis, 67% of A. americanum, and 50% of I. scapularis. Metofluthrin was slightly more effective, deterring 81% of D. variabilis, 73% of A. americanum, and 72% of I. scapularis. The present study poses a novel paradigm for repellency and reports a preliminary assessment of spatial repellent effect on tick behavior. Further research will assess spatial repellency in a more natural setting, scale exposure conditions, and incorporate host cues. [ABSTRACT FROM AUTHOR]

Cutaneous cancer is a rare entity accounting for less than 1% of all diagnosed cancers in India. In contrast to the West, squamous cell carcinoma is the commonest skin cancer in India, often affecting the scalp. However, due to their rarity, not much is known regarding their biological behavior and prognosis. The present study is a retrospective cohort study undertaken in a tertiary cancer centre on 19 consecutive cases of squamous cell carcinoma of the scalp over a period of 5 years. Patients with non-sqamous histology and those associated with xeroderma pigmentosum were excluded. Nineteen patients were evaluated with a mean age of 52.7 years. Majority presented with a swelling (11 patients; 57.9%) in the parieto-occipital region (13 patients; 68.4%). All patients underwent wide excision with or without excision of underlying bone or dura, depending on involvement. Only 4 (21%) required major reconstruction. On histopathology, 8 (42.1%) were poorly differentiated, while 3 (15.8%) had presence of perineural invasion (PNI). The mean duration of follow-up was 38.14 months. Three of the 4 (75%) and 2 of 3 (66.67%) patients with poorly differentiated histology and PNI respectively developed recurrence, while only 1 of the 6 (16.67%) with close or positive base margin developed recurrence. Hence, to conclude, poorly differentiated histology and PNI are poor prognostic indicators, while in the event the mucoperiosteum is clinically uninvolved, the underlying bone may be preserved in select cases, even if the base margin is close. [ABSTRACT FROM AUTHOR]

Introduction: MegaShield® is a newly developed temperature-sensitive anti-adhesive containing micronized acellular dermal matrix. The aim of this study was to investigate the efficacy and safety of MegaShield® compared with Guardix-SG® in the prevention of adhesions in patients undergoing bilateral total thyroidectomy. Method: We conducted a multicenter trial between October 2018 and March 2020 in patients undergoing total thyroidectomy. The patients were randomly assigned to either the MegaShield® group or the Guardix-SG® group. The primary outcome was the esophageal movement using marshmallow six weeks after the surgery and the secondary outcome was the assessed adhesion score. The safety assessment was also evaluated. Results: The study included 70 patients each in the MegaShield® and control (Guardix-SG®) groups. Baseline clinical characteristics, the mean score of marshmallow esophagography, and the sum of adhesion scores were not statistically different between the two groups. Inferiority test demonstrated that the efficacy of MegaShield® is not inferior to that of Guardix-SG®. There were no device-related complications in both groups. Conclusion: The efficacy and safety of MegaShield® were not inferior than those of Guardix-SG®. MegaShield® demonstrated the potential of ADM as a potential future anti-adhesive agent. Trial registration: The name of trial registry CRIS (Clinical Research Information Service) https://cris.nih.go.kr/cris/index.jsp. (The full trial protocol can be accessed) Registration number: KCT0003204. [ABSTRACT FROM AUTHOR]

Background: Rosacea is a chronic inflammatory skin condition of varying severity that can significantly impact patient quality of life. Intense pulsed light (IPL) is an established treatment for rosacea‐associated telangiectasia, inflammation, and erythema. This study assessed whether application of a phyto‐corrective mask, gel, and resveratrol antioxidant serum after IPL treatment can improve outcomes and reduce procedure‐related adverse effects. Methods: In a prospective, open‐label, split‐face, 3‐month study, 10 subjects with moderate‐to‐severe facial rosacea underwent IPL treatment on both sides of the face. The following were applied to the right side of the face only: phyto‐corrective mask once weekly starting immediately after IPL; phyto‐corrective gel twice daily; and resveratrol antioxidant treatment at night. Both sides of the face were treated with sunscreen. Subjects were assessed on Day 1, 1 and 3 months after IPL by three, independent evaluators using the 5‐point Global Aesthetic Improvement Scale (GAIS). All subjects rated skin redness, hydration, and overall improvement on Day 1 and completed a patient satisfaction questionnaire at the 1‐ and 3‐month visits. Results: Ten women were enrolled, aged 44–72 years old, with moderate (n = 6) to severe (n = 4) rosacea. IPL was effective at reducing symptoms with rosacea classified as absent in five women and mild in five at the final 3‐month visit. GAIS scores also revealed improvements on both sides of the face, but the skincare treated side showed continuous improvement over 3 months with all patients remaining at least "Improved", whereas there appeared to be a waning effect after 1 month with IPL alone. On Day 1 after IPL, all women reported less redness, improved hydration, and improved skin appearance on the right side of the face. Patient satisfaction was consistently rated higher on the right side of the face. Conclusion: Application of a phyto‐corrective mask, gel, and resveratrol antioxidant serum may complement IPL treatment for rosacea by enhancing treatment outcomes and reducing procedure‐related symptoms. [ABSTRACT FROM AUTHOR]