Primary Immature Renal Teratoma in a Neonate.

Teratomas are neoplasms that commonly arise from the gonads. It is rare that they originate in the kidney. Immature intrarenal teratomas are exceptionally rare. To our knowledge, the current case will be the fifth immature intrarenal teratoma reported in the literature, in addition to being the first such case reported in a neonate.

Current concepts in the pathogenesis of periodontitis: from symbiosis to dysbiosis.

The primary etiological agent for the initiation and progression of periodontal disease is the dental plaque biofilm which is an organized aggregation of microorganisms residing within a complex intercellular matrix. The non-specific plaque hypothesis was the first attempt to explain the role of the dental biofilm in the pathogenesis of periodontal diseases. However, the introduction of sophisticated diagnostic and laboratory assays has led to the realisation that the development of periodontitis requires more than a mere increase in the biomass of dental plaque. Indeed, multispecies biofilms exhibit complex interactions between the bacteria and the host. In addition, not all resident microorganisms within the biofilm are pathogenic, since beneficial bacteria exist that serve to maintain a symbiotic relationship between the plaque microbiome and the host's immune-inflammatory response, preventing the emergence of pathogenic microorganisms and the development of dysbiosis. This review aims to highlight the development and structure of the dental plaque biofilm and to explore current literature on the transition from a healthy (symbiotic) to a diseased (dysbiotic) biofilm in periodontitis and the associated immune-inflammatory responses that drive periodontal tissue destruction and form mechanistic pathways that impact other systemic non-communicable diseases.

Safety of Pregnancy in Ventriculoperitoneal Shunt Dependent Women: Meta-analysis and Systematic Review of the Literature.

OBJECTIVE: To assess the safety of pregnancy in ventriculoperitoneal (VP) shunt-dependent women. METHODS: Three electronic databases MEDLINE (PubMed), EMBASE, and the Cochrane Library were systematically searched to identify studies published in English between 1950 and 2019. We additionally searched Web of Science, Google Scholar, and ClinicalTrials.gov. RESULTS: Among the 38 cases of pregnant VP shunt-dependent women, median age was 25.5 years and shunting duration was 15.5 years with 11 women being shunted at birth or soon after. Congenital diseases were the most common reason for shunting, present in 63.2% of women. The antepartum complications were reported in 50% of cases with the symptoms of increased ICP being the most commonly reported (73.7%). In the majority of cases the complications were resolved with cerebrospinal fluid aspiration (26.3%). Eight women (42.1%) had spontaneous vaginal delivery, 4 had assisted vaginal delivery, while 7 women underwent cesarian section. There was one fetal demise occurred in a woman that was diagnosed with tuberous sclerosis and presented with status epilepticus during the pregnancy. CONCLUSION: A multidisciplinary approach is needed in managing the VP shunts during the pregnancy and post-partum periods to ensure the best pregnancy outcome for both mothers and the fetus. Based on our findings, VP shunt appears not to be a contraindication for pregnancy. The routine use of prophylactic antibiotics to prevent shunt infection is not recommended. Vaginal delivery should be attempted unless a cesarean section is inevitably required for obstetrics reasons.

Dermatology consultations: how long do they take?

The rising demand for dermatology services calls for more -efficient clinics. However, there is a lack of evidence to guide the allocation of time for dermatological consultations. Our study analysed 607 dermatology consultations led by 23 clinicians. Consultation lengths were found to be dependent on the grade of clinician seen, nature of attendance (new or follow-up) and nature of final diagnosis. The median times taken for all consultations involving general dermatological conditions or suspected skin tumours were 16.5 minutes (IQR 12.8-24.1) and 15.5 minutes (IQR 11.7-20.1), respectively (p=0.001). Consultations with new patients took longer than follow-up cases (p<0.001). Based on our results, new patients presenting with general dermatological conditions should be allocated 25 minutes per consultant-led consultation, while follow-up cases can be allocated 15 minutes per consultation. We recommend similar analyses of consultation lengths in other specialties to inform the development of efficient, specialty-specific clinic models.

Medium-depth chemical peels in the treatment of acne scars in dark-skinned individuals.

BACKGROUND: Multiple modalities are available for treating acne scars, one of which is chemical peeling. OBJECTIVE: To evaluate the efficacy of medium-depth peels in the treatment of acne scars. METHODS: A total of 15 patients (14 women and 1 man) were seen between November 1998 and March 2000. A medium-depth chemical peel was performed. The peel was performed using a combination of Jessner's solution followed by the application of 35% trichloroacetic acid (TCA). The mean age of patients who entered the study was 28 years. A total of 42 peeling sessions were performed: 13 patients had the full three-session regiment, 1 patient had two sessions, and 1 had only one session. RESULTS: Patients in our study had two forms of acne scars, the atrophic saucer or crater-like form and the pitted (ice-pick) form. Improvement occurred in all except one of our patients. Significant improvement (greater than 75% clearance of lesions) occurred in 1 patient (6.6%), moderate improvement (51-75% clearance) in 8 patients (53.3%), mild improvement (26-50% clearance) in 4 patients (26.6%), minimal improvement (1-25% clearance) in 1 patient (6.6%), and no response in 1 patient (6.6%). All patients had different combinations of the above two forms. Four patients (26.6%) had mainly pitted scars and deep atrophic scars. The clinical response in those patients was moderate, mild, minimal, and no response, respectively. The remainder of our patients had mainly atrophic scars of moderate depth. Nine patients (73.4%) suffered from transient postinflammatory hyperpigmentation. In two of them it was preceded by erythema that lasted for more than 1 month. All patients were free of noticeable pigmentation 3 months after the final peel. Patients in whom hyperpigmentation did not develop were of light brown complexion. CONCLUSION: We conclude that medium-depth chemical peel is a safe and effective method of treating acne scars even in patients with dark complexion.