Patterns and management outcome of paediatrics burn in a general surgical department: experience from a secondary referral hospital.

Burns are considered the fourth most common type of traumatic injury worldwide with significant morbidity and mortality. The aim of this study is to disclose the incidence, etiological factors, treatment and outcome of paediatric burns in Sudan. This is a retrospective hospital-based study, conducted during 2016-2019. Patients who presented with burn injuries and managed in the hospital were included in the study. Flowchart sheets were used to collect the data. Then, it was entered and analysed using Statistical Package for the Social Sciences version 21 statistical software (IBM Corporation, Chicago, IL). The total number of patients who fulfill our criteria is 85 with a median age of 4 years (7 months-15 years). Sixty-five percent of them were under 5 years with male predominance (55%). Most patients' burns occurred at home. The median percentage of burn is 18% (2%-90%) which is caused by scalding burn among 55.3% followed by the flame burn in 41.2% of patients. Regarding fluid management, 60% received fluid. Open dressing for burn wounds was done for 75% and close dressing among 15% of patients. More than 80% of the patients in this study were treated and discharged in a good condition while the mortality was 5.9%. This study showed the significant burden of paediatric burns management on general surgery units in a referral hospital. Therefore, equipping the hospital and founding these specialities will decrease this load and will improve the outcome.

The Use of Janus Kinase Inhibitors for Lichen Planus: An Evidence-Based Review.

BACKGROUND: Lichen Planus (LP) is a dermatological disorder characterized by violaceous papules that affect the cutaneous region, nails, scalp, and mucous membranes. Current molecular and clinical studies point to the Janus Kinase-signal transducer and activator of transcription (JAK-STAT) pathway as a potential effector of LP pathology. OBJECTIVE: This systematic review summarizes the current reported literature outcomes for patients receiving JAK inhibitors to treat LP. METHODS: MEDLINE and Embase were searched on 16 October, 2022, and 15 original articles were included, with 56 LP patients. RESULTS: (mean age: 54.5 years, range: 26-81 years, male: 26.8%). The treatment outcomes were included for the following JAK inhibitors: tofacitinib (n = 30), baricitinib (n = 16), ruxolitinib (n = 12), and upadacitinib (n = 2). Patient outcomes were classified into complete resolution, partial resolution, and no resolution. Patients achieving complete resolution represented 25% (n = 4/16) in the baricitinib group, 10% (n = 3/30) in the tofacitinib group, 16.7% (n = 2/12) in the ruxolitinib group, and 100% (2/2) in the upadacitinib group. Partial resolution patients represented 31.3% (n = 5/16) of baricitinib patients, 60% (n = 18/30) of tofacitinib patients, and 83% (n = 10/12) of ruxolitinib patients. 43.8% (n = 7/16) of baricitinib patients and 10% (n = 9/30) of tofacitinib patients had no resolution of lesions. CONCLUSION: This review also highlights the significance of utilizing a uniform outcome measure for LP, as it aids in reporting more generalizable results, reduces reporting bias, and ultimately lead to improved clinical outcomes for LP patients.

Diagnostic Accuracy of Ankle-Brachial Pressure Index Compared with Doppler Arterial Waveforms for Detecting Peripheral Arterial Disease: A Systematic Review.

GENERAL PURPOSE: To present the results of a research study evaluating the diagnostic accuracy of the ankle-brachial pressure index (ABPI) compared with that of Doppler arterial waveforms (DAWs) to detect peripheral arterial disease (PAD). TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After completing this continuing education activity, the participant will:1. Summarize the evidence the authors considered when comparing the diagnostic accuracy of the ABPI with that of Doppler arterial waveforms to detect PAD.2. Select the characteristics of the participants in the studies the authors analyzed.3. Identify the results of the authors' study comparing the diagnostic accuracy of the ABPI with that of Doppler arterial waveforms to detect PAD.4. Distinguish the authors' conclusions about the advantages of using Doppler arterial waveforms to detect PAD.

Although the ankle-brachial pressure index (ABPI) is a useful tool for the noninvasive assessment of peripheral arterial disease (PAD), it has several limitations necessitating alternative noninvasive diagnostic tools. This study assesses the diagnostic accuracy of ABPI compared with Doppler arterial waveforms (DAWs) to detect PAD. The authors searched Embase and MEDLINE for original studies that reported sensitivities and specificities for both the ABPI and DAW. Four studies were included representing 657 patients (58.8% men) with a mean age of 63.4 years. The authors detected overall higher sensitivities using DAW compared with ABPI but higher specificities with ABPI compared with DAW. In conclusion, because of the higher sensitivity and lower specificity of DAW compared with ABPI, the authors recommend DAW as a potential screening tool for PAD. To confirm these results, larger sample sizes and comparative trials with homogeneous reference standards and patient populations are required. In addition, DAW is not easily documented for everyday bedside practice in the community. With COVID-19 restrictions, an audible handheld Doppler signal may act as a reproducible equivalent to DAW and thus facilitate timely, safe application of compression therapy at point-of-care.

Biologic treatment outcomes in mucous membrane pemphigoid: A systematic review.

BACKGROUND: Mucous membrane pemphigoid (MMP) is an autoimmune disease that can lead to fibrosis of mucous membranes and functional impairment. Biologic agents should be explored as alternative treatment options to improve outcomes. OBJECTIVE: To conduct a systematic review of biologic treatment outcomes in patients with MMP. METHODS: A MEDLINE and Embase search was conducted on July 23, 2020, to include 63 studies using Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. RESULTS: Use of intravenous immunoglobulin (n = 154), rituximab (n = 112), tumor necrosis factor α inhibitors (n = 7), and combination treatments (n = 58) were reported in 331 patients with MMP. Intravenous immunoglobulin led to complete resolution in 61.7% (n = 95/154) of patients within 26.0 months, with a recurrence rate of 22.7% (n = 35/154) and headache as the most common adverse effect (8.4%, n = 13/154). Rituximab led to complete resolution in 70.5% (n = 79/112) of patients within 8.7 months, with a recurrence rate of 35.7% (n = 40/112). The most commonly reported adverse effects were urinary tract infections (4.5%, n = 5/112), leukocytopenia (2.7%, n = 3/112), and death due to severe infections (1.8%, n = 2/112). Tumor necrosis factor α inhibitors led to complete resolution in 71.4% (n = 5/7) of patients within 3.9 months of treatment without reported adverse events. CONCLUSIONS: Randomized clinical trials with long-term follow-up are required to conclude the promising safety and efficacy of biologic agents in patients with MMP.

Squamous cell carcinoma arising within hidradenitis suppurativa: a literature review.

Squamous cell carcinoma (SCC) can present as a rare complication of longstanding hidradenitis suppurativa (HS) lesions. Limited data exist on characteristics and outcomes of SCC development within HS lesions. The purpose of this review is to conduct a literature review of previously reported cases of SCC development in pre-existing HS lesions. EMBASE and MEDLINE searches were conducted in OVID on June 25, 2020, to yield 59 studies. Of the 95 patients (mean age: 52.9 years) who developed a total of 122 SCCs within HS lesions, the majority were males (77.9%, n = 74/95). The most common sites of SCC were the gluteal region (47.5%, n = 58/122), the perianal region (18.9%, n = 23/122), and the genitals (13.9%, n = 17/122). The mean duration between HS onset and SCC development was 25.5 years. Of the patients that had outcomes reported, 54.0% (n = 34/63) experienced SCC metastasis, 43.1% (n = 28/65) experienced SCC recurrences, and 58.7% (n = 44/75) experienced a mortality outcome. The most common documented reasons for death included metastasis (34.1%, n = 15/44) and sepsis (13.6%, n = 6/44). Patients with longstanding HS lesions can develop SCCs with a high rate of metastasis and mortality. Thus, chronic HS lesions, especially in the gluteal, perianal, genital, and perineal regions, should be monitored regularly for timely SCC diagnosis and management.

Exercise and estrogen: common pathways in Alzheimer's disease pathology.

Alzheimer's disease (AD) is a neurodegenerative disease that is characterized by progressive declines in cognitive function. Current epidemiological data indicate significant sex-linked disparities, where females have a higher risk of developing AD compared with male counterparts. This disparity necessitates further investigations to uncover the pathological and molecular factors influencing these sex differences. Although the underlying pathways behind this observed disparity remain elusive, recent research points to menopausal estrogen loss as a potential factor. Estrogen holds a significant role in amyloid precursor protein (APP) processing and overall neuronal health through the regulation of brain-derived neurotrophic factor (BDNF), a factor that is also reduced in postmenopausal women. BDNF is a known contributor to neuronal health and its reduced expression is typically linked to AD disorders. Exercise is known to increase BDNF and may provide an accessible activity for postmenopausal women to reduce their risk of AD. This review aims to discuss the relationship between estrogen, exercise, and BDNF in AD pathology.

Resveratrol, Metabolic Dysregulation, and Alzheimer's Disease: Considerations for Neurogenerative Disease.

Alzheimer's disease (AD) has traditionally been discussed as a disease where serious cognitive decline is a result of Aß-plaque accumulation, tau tangle formation, and neurodegeneration. Recently, it has been shown that metabolic dysregulation observed with insulin resistance and type-2 diabetes actively contributes to the progression of AD. One of the pathologies linking metabolic disease to AD is the release of inflammatory cytokines that contribute to the development of brain neuroinflammation and mitochondrial dysfunction, ultimately resulting in amyloid-beta peptide production and accumulation. Improving these metabolic impairments has been shown to be effective at reducing AD progression and improving cognitive function. The polyphenol resveratrol (RSV) improves peripheral metabolic disorders and may provide similar benefits centrally in the brain. RSV reduces inflammatory cytokine release, improves mitochondrial energetic function, and improves Aß-peptide clearance by activating SIRT1 and AMPK. RSV has also been linked to improved cognitive function; however, the mechanisms of action are less defined. However, there is evidence to suggest that chronic RSV-driven AMPK activation may be detrimental to synaptic function and growth, which would directly impact cognition. This review will discuss the benefits and adverse effects of RSV on the brain, highlighting the major signaling pathways and some of the gaps surrounding the use of RSV as a treatment for AD.

Can We Separate Oral Lichen Planus from Allergic Contact Dermatitis and Should We Patch Test? A Systematic Review of Chronic Oral Lichenoid Lesions.

This systematic review summarizes characteristics and treatment outcomes of dental amalgam-associated oral lichenoid lesions (OLLs) and oral lichen planus (OLP). Embase and MEDLINE were searched for original studies on OLLs or OLP associated with dental amalgam. Data extraction was completed from 44 studies representing 1855 patients. Removal of amalgam restorations led to complete resolution in 54.2% (n = 423/781), partial resolution in 34.8% (n = 272/781), and no resolution in 11.0% (n = 86/781) of the patients with OLLs, whereas complete resolution occurred in 37.1% (n = 72/194), partial resolution in 26.3% (n = 51/194), and no resolution in 36.6% (n = 71/194) of the patients with OLP. For patients with OLLs, 91.6% of the patients with positive patch tests and 82.9% with negative patch tests had improvement with removal of amalgam, whereas for patients with OLP, 89.2% of the patients with positive patch tests and 78.9% with negative patch tests had improvement with removal of amalgam. Our results suggest improvement occurs, regardless of patch testing status.