Functional Recovery and Regenerative Effects of Direct Transcutaneous Electrical Nerve Stimulation in Treatment of Post-COVID-19 Guillain-Barré and Acute Transverse Myelitis Overlap Syndrome: A Clinical Case.

Transcutaneous electrical nerve stimulation (TENS) has proven effective in treating pain in many experimental and clinical studies. In addition to the analgesic effect, direct TENS of peripheral nerves had anti-inflammatory and regenerative effects in the treatment of distal polyneuropathy and spinal cord injury. This work demonstrates the experience of using direct TENS in the treatment of a 52-year-old patient with post-COVID-19 Guillain-Barré (GBS) and acute transverse myelitis (ATM) overlap syndrome. Direct TENS of peripheral nerves showed high efficiency in enhancing the therapeutic effect of combined plasma exchange and pharmacotherapy by 89.5% with a significant reduction in neuropathic pain, motor and sensory deficits, bladder and bowel disorders and regression of neurophysiological changes. We suggest that direct TENS of peripheral nerves can be a promising option for combined therapy of GBS and ATM overlap syndrome and other diseases with the simultaneous development of distal polyneuropathy and spinal cord injury. Further trial studies are required.

Changing our microbiome: probiotics in dermatology.

BACKGROUND: Commensal bacteria are a major factor in human health and disease pathogenesis. Interest has recently expanded beyond the gastrointestinal microbiome to include the skin microbiome and its impact on various skin diseases. OBJECTIVES: Here we present current data reviewing the role of the microbiome in dermatology, considering both the gut and skin microflora. Our objective was to evaluate whether the clinical data support the utility of oral and topical probiotics for certain dermatological diseases. METHODS: The PubMed and ClinicalTrials.gov databases were searched for basic science, translational research and clinical studies that investigated differences in the cutaneous microbiome and the impact of probiotics in patients with atopic dermatitis, acne vulgaris, psoriasis, chronic wounds, seborrhoeic dermatitis and cutaneous neoplasms. RESULTS: Few clinical trials exist that explore the utility of probiotics for the prevention and treatment of dermatological diseases, with the exception of atopic dermatitis. Most studies investigated oral probiotic interventions, and of those utilizing topical probiotics, few included skin commensals. In general, the available clinical trials yielded positive results with improvement of the skin conditions after probiotic intervention. CONCLUSIONS: Oral and topical probiotics appear to be effective for the treatment of certain inflammatory skin diseases and demonstrate a promising role in wound healing and skin cancer. However, more studies are needed to confirm these results. What's already known about this topic? The microbiome plays a role in human health and disease pathogenesis. Probiotics can manipulate the host microbiome and may confer health benefits for patients. Research to date has already begun to explore the utility of oral and topical probiotics for certain dermatological diseases. What does this study add? This review presents basic science and clinical trial data to support the role of the gut and skin microbiome in dermatology. Current data are reviewed on the use of probiotics in the prevention and treatment of skin diseases, including atopic dermatitis, acne vulgaris, psoriasis, seborrhoeic dermatitis, chronic wounds and cutaneous neoplasms. Future probiotic interventions are proposed.

Hidradenitis suppurativa: a review with a focus on treatment data.

Hidradenitis suppurativa (HS) is a chronic disease of the follicular unit that often leads to marked impairment of quality of life and usually affects the axillary, perineum and inframammary regions resulting in tender subcutaneous nodules, abscesses, fibrosis and sinus tract formation. New updates on HS underscores the role of various genes as well as the innate and adaptive immune response in its pathogenesis. Although every patient requires an individualized approach to treatment, topical therapy and antibiotics are mainly used for mild to moderate disease, whereas various systemic immune modulators and/or surgical approaches play a pivotal role in moderate to severe disease. New treatments using various immune modulators, laser modalities and other novel agents provide clinicians with better ways of managing HS.

Portable video media for presenting informed consent and wound care instructions for skin biopsies: a randomized controlled trial.

BACKGROUND: In fast-paced dermatology clinics, the process of obtaining informed consents for biopsies and providing postprocedure instructions may be incomplete and inconsistent. OBJECTIVES: To compare effectiveness of video-based education with that of verbal education for giving informed consent and providing postprocedure wound care instructions in patients undergoing skin biopsies. METHODS: In this randomized controlled trial, participants were randomized to receive either video education on portable video devices or conventional verbal instructions regarding skin biopsies. Participants completed a skin-biopsy knowledge assessment, patient satisfaction assessment and evaluation of educational medium. Main outcome measures were differences in the changes in the prestudy and poststudy knowledge assessment scores, patient satisfaction and evaluation of the educational medium. RESULTS: Eight-four patients undergoing skin biopsies at the University of California Davis dermatology clinic participated in the study. Participants in the control group had a nonstatistically significant increase in knowledge score (mean ± SD 1·12 ± 1·74), whereas those in the video group had a statistically significant increase in knowledge score (mean ± SD 1·55 ± 1·71). The difference in knowledge scores between the video and verbal groups was not statistically significant. Participants in both groups were highly satisfied with the biopsy education. On a 10-point scale, the mean ± SD usefulness and appeal of the videos were 9·01 ± 1·5 and 9·01 ± 1·66, respectively. CONCLUSIONS: Our study demonstrated a significant increase in knowledge score following video education, but not following oral education. Although between-group comparisons did not achieve statistical significance, portable video media for presenting informed consent and wound care instructions for skin biopsies appear to be more effective and result in higher satisfaction than traditional oral education.

Identification of a mouse orthologue of the CED-6 gene of Caenorhabditis elegans.

The rapid engulfment of apoptotic cells is a specialized innate immune response used by organisms to remove apoptotic cells. In mammals, several receptors that recognize apoptotic cells have been identified. Previous analysis of the engulfment gene ced-6 in Caenorhabditis elegans (C. elegans) has suggested that CED-6 is an adapter protein that participates in signal transduction pathway that mediates the specific recognition and engulfment of apoptotic cells. Here, we describe our isolation and partial characterization of a mouse cDNA, which is like an orthologue of C. elegans CED-6. PCR screening of mouse cDNA pool with primers designed from the C. elegans CED-6 cDNA sequence resulted in about 300 bp PCR product which was partially sequenced and then screened to a mouse full-length cDNA library. Thus in this study we report the identification of a novel C. elegans CED-6-like orthologue in mouse, which has probable apoptotic like function.

Tumour necrosis factor-alpha gene promoter polymorphism in chronic obstructive pulmonary disease.

Tumour necrosis factor(TNF)-alpha levels are elevated in airways of patients with chronic obstructive pulmonary disease (COPD) and may contribute to its pathogenesis. A guanine to adenine substitution at position -308 of the TNF-alpha gene promoter (TNF1/2) has been associated with chronic bronchitis of various aetiologies in a Taiwanese population. The authors performed a study investigating association of the polymorphism with smoking-related COPD in Caucasians. Frequencies of TNF1/2 alleles in 86 Caucasians (52 males) with COPD were compared with 63 (52 males) asymptomatic smoker/exsmoker control subjects and a population control of 199 (99 males) blood donors. Genotyping was performed by the polymerase chain reaction-restriction fragment length polymorphism technique on genomic deoxyribonucleic acid (DNA) obtained from peripheral blood. There were no significant differences in TNF1/2 allele frequencies between groups: 0.85/0.15 in COPD, 0.85/0.15 in smoker control subjects, 0.83/0.17 in population control subjects. Within the COPD group there was no association of TNF1/2 alleles with indices of airflow obstruction (% predicted forced expiratory volume in one second (FEV1) and % predicted FEV1/vital capacity ratio) nor gas transfer (% predicted carbon monoxide transfer coefficient and % predicted carbon monoxide diffusing capacity of the lung). It is concluded that: 1) the tumour necrosis factor gene promoter allele does not influence the risk of developing chronic obstructive pulmonary disease in a Caucasian population of smokers; and 2) there is no association of the tumour necrosis factor gene promoter genotype with severity of airflow obstruction nor degree of emphysema in chronic obstructive pulmonary disease.

Filarial antibody detection in suspected occult filariasis in children in an endemic area.

A study was conducted in filarial endemic area for diagnosis of occult filariasis in various clinical conditions in children. Thirty-five age- and sex-matched controls (endemic-15, non-endemic-10, disease control-10), 16 classical lymphatic filariasis, and 92 occult filariasis (clinical conditions which fall in the spectrum of occult filariasis and suspected to be filarial), were subjected to peripheral night blood smear examination for microfilaria (mf) and stick ELISA test using mf ES antigen for filarial antibodies. In the control group none showed mf and only 3 per cent (1/35) among endemic control were positive for filarial antibodies. In classical filariasis 1 per cent (2/16) showed mf and 94 per cent (15/16) had filarial antibodies. In suspected occult filariasis 1 per cent (one case of arthritis) showed mf and 62 per cent (57/92) showed filarial antibodies. These consisted of tropical pulmonary eosinophilia 63 per cent (15/24), arthritis where no cause could be ascertained on investigation 64 per cent (27/42), nephrotic syndrome 69 per cent (11/16), acute glomerulonephritis with ASO < 200 units 38 per cent (3/8), and cardiomyopathy 50 per cent (1/2). Correlation with age showed that 80 per cent (4/5) of cases of arthritis seen in 0-4 years of age group and 82 per cent (11/9) of nephrotic syndrome in the 10-14 years of age group were positive for filarial antibody. Arthritis due to other causes and minimal change nephrotic syndrome are uncommon in these respective age groups. It is concluded that the role of filariasis in endemic areas in these disease states cannot be denied and needs to be studied further.

Immunomonitoring of filarial patients during DEC therapy in an endemic area: a seven-year follow-up.

A group of 27 Wuchereria bancrofti infected persons from an endemic area, who had undergone treatment with diethylcarbamazine (DEC), were followed for 7 years to understand its effect on microfilaraemia, immune status and on the recurrence of infection. Treatment with DEC was for 14 days (day 1, 1 mg kg-1 body weight, day 2, 2 mg kg-1 body weight and from day 3 onwards 6 mg kg-1 body weight) followed by one dose (6 mg kg-1 body weight) on days 360, 540 and at the end of years 2, 3, 4, 6 and 7. After a 2-year follow-up the patients were divided into two groups. Group A consisted of cases that showed no reappearance of microfilariae (mf) and Group B of those cases that showed reappearance of mf. Further follow-up in the next 5 years showed that none of the cases in Group A were positive for mf at any time. In contrast, mf were detected in Group B in 14, 15, 27 and 33% of the cases followed at the end of years 3, 4, 6 and 7 respectively. Both groups showed a decrease in filarial IgG antibody and mf excretory-secretory antigen levels in the initial 4 years followed by increased levels at the end of years 6 and 7. The reappearance of filarial antibody and antigen in 50-70% of Group A and 68-100% of Group B at the end of year 7 suggests the existence of active infection in these cases. No cases followed in this study developed clinical symptoms. This study shows that long-term DEC therapy and immunomonitoring of mf patients is essential in an endemic area for arresting transmission and prevention of pathology associated with clinical manifestations.

Filarial antigen, antibody and circulating immune complexed antigen levels in Bancroftian filariasis by stick ELISA.

Filarial antigen, antibody and circulating immune complexed antigen (CIC-Ag) profiles were studied by stick ELISA in the sera of patients who were in different stages of Bancroftian filarial infection. The geometric mean titres (GMT), of filarial IgG antibody in patients with microfilaraemia (424) and all three grades of clinical filariasis (1485, 3845 and 40216 for grades I, II and III respectively), were significantly higher than in normal controls from endemic areas (47). If a filarial antibody titre of greater than 300 is considered positive, the sera of 94% of patients with microfilaraemia and all those with clinical filariasis were positive. The sera of only 11% of normal subjects from endemic areas and none from non-endemic areas were positive for filarial antibody. The antibody titres were significantly higher in patients with grades II and III clinical filariasis than in those with grade I clinical filariasis or microfilaraemia. Analysis of sera for filarial antigen by inhibition ELISA showed higher GMTs in patients with microfilaraemia (5778) and grades I (3917) and II (676) clinical filariasis compared to grade III (66) clinical filariasis or normal subjects from endemic areas (57). Thus 81% of patients with microfilaraemia, 85% with grade I, 88% with grade II and 20% with grade III clinical filariasis and none of the normal subjects from either endemic or non-endemic areas had a filarial antigen titre of greater than 300. CIC-Ag was found to be present in 8% of patients with grade I, 21% with grade II and 79% with grade III clinical filariasis and in none of those with microfilaraemia or normal controls. While the detection of filarial antibody is useful for diagnosing. microfilaraemia and clinical filariasis, the detection of filarial antigen may be superior for diagnosis of microfilaraemia and grade I clinical filarial infection. Assay of CIC-Ag is useful for diagnosing a grade III clinical infection in the absence of microfilariae in the blood.