Cosmetic Treatments with Energy-Based Devices in Skin of Color.

The use of energy-based devices in cosmetic treatments for patients with higher Fitzpatrick skin types is a topic of concern due to the increased risk of complications such as hyperpigmentation and scarring. Advancements in technology have enabled the development of safe and effective energy-based modalities for improving skin tone, texture, and signs of aging in patients with higher Fitzpatrick skin types. This article reviews various modalities that have shown positive outcomes in Fitzpatrick skin types 4 to 6.Radiofrequency (RF) skin tightening devices have emerged as a noninvasive method for improving skin laxity by stimulating collagen and elastin production without generating excessive heat, making them suitable for darker skin tones. Microfocused ultrasound (MFUS) is another noninvasive option for skin tightening and lifting. By producing thermal coagulation in the deeper layers of the skin, MFUS stimulates collagen production, resulting in improved skin tightness. Fractional laser resurfacing, both ablative and nonablative, offers effective treatment options for various concerns such as acne scars, skin texture, and dyspigmentation. Nonablative fractional lasers, which target water rather than melanin, are particularly safer for darker skin types. Broadband light devices that emit different wavelengths have shown success in skin rejuvenation, improving wrinkles, pore size, erythema, telangiectasias, and dyspigmentation. Additionally, RF microneedling combines the benefits of both modalities, delivering safe treatment for skin laxity and textural concerns. The short-pulse neodymium-doped yttrium aluminum garnet (Nd:YAG) laser has become a transformative tool for patients with Fitzpatrick skin types 4 to 6. This laser targets melanin, hemoglobin, and water, providing improvements in hyperpigmentation, acne, fine lines, and scar texture. Combining the short-pulse Nd:YAG laser with other treatments like chemical peels or microneedling has shown synergistic effects and enhanced outcomes. Understanding these modalities and tailoring treatments to specific concerns is crucial for safe and effective solutions in patients with higher Fitzpatrick skin types.

Anticipating the curve: can online symptom-based data reflect COVID-19 case activity in Ontario, Canada?

BackgroundLimitations in laboratory diagnostic capacity and reporting delays have hampered efforts to mitigate and control the ongoing COVID-19 pandemic globally. Syndromic surveillance of COVID-19 is an important public health tool that can help detect outbreaks, mobilize a rapid response, and thereby reduce morbidity and mortality. The primary objective of this study was to determine whether syndromic surveillance through self-reported COVID-19 symptoms could be a timely proxy for laboratory-confirmed case trends in the Canadian province of Ontario. MethodsWe retrospectively analyzed self-reported symptoms data collected using an online tool - Outbreaks Near Me (ONM) - from April 20th to Oct 11th, 2020 in Ontario, Canada. We estimated the correlation coefficient between the weekly proportion of respondents reporting a COVID-like illness (CLI) to both the weekly number of PCR-confirmed COVID-19 cases and the percent positivity in the same period for the same week and with a one-week lag. ResultsThere were 314,686 responses from 188,783 unique respondents to the ONM symptom survey. Respondents were more likely to be female and be in the 40-59 age demographic compared to the Ontario general population. There was a strong positive correlation between the weekly number of reported cases in Ontario and the percent of respondents reporting CLI each week (r = 0.89, p <0.01) and with a one-week lag (r = 0.89, p <0.01). InterpretationWe demonstrate a strong positive and significant correlation (r = 0.89, p <0.01) between percent of self-reported COVID-like illness and the subsequent weeks COVID-19 cases reported, highlighting that a rise in CLI may precede official statistics by at least 1 week. This demonstrates the utility of syndromic surveillance in predicting near-future disease activity. Digital surveillance systems are low-cost tools that may help measure the burden of COVID-19 in a community if there is under-detection of cases through conventional laboratory diagnostic testing. This additional information can be used to guide a healthcare response and policy decisions.

The impact of seasonal respiratory virus transmission on syndromic surveillance for COVID-19 in Ontario, Canada

BackgroundSyndromic surveillance systems for COVID-19 are being increasingly used to track and predict outbreaks of confirmed cases. Seasonal circulating respiratory viruses share syndromic overlap with COVID-19, and it is unknown how they will impact the performance of syndromic surveillance tools. Here we investigated the role of non-SARS-CoV-2 respiratory virus test positivity on COVID-19 two independent syndromic surveillance systems in Ontario, Canada. MethodsWe compared the weekly number of reported COVID-19 cases reported in the province of Ontario against two syndromic surveillance metrics: 1) the proportion of respondents with a self-reported COVID-like illness (CLI) from COVID Near You (CNY) and 2) the proportion of emergency department visits for upper respiratory conditions from the Acute Care Enhanced Surveillance (ACES) system. Separately, we plotted the percent positivity for other seasonal respiratory viruses over the same time period and reported Pearsons correlation coefficients before and after the uncoupling of syndromic tools to COVID-19 cases. ResultsThere were strong positive correlations of both CLI and ED visits for upper respiratory causes with COVID-19 cases up to and including a rise in entero/rhinovirus (r = 0.86 and 0.87, respectively). There was a strong negative correlation of both CLI and ED visits for upper respiratory causes with COVID-19 cases (r = -0.85 and -0.91, respectively) during a fall in entero/rhinovirus. InterpretationTwo methods of syndromic surveillance showed strong positive correlations with COVID-19 confirmed case counts before and during a rise in circulating entero/rhinovirus. However, as positivity for enterovirus/rhinovirus fell in late September 2020, syndromic signals became uncoupled from COVID-19 cases and instead tracked the fall in entero/rhinovirus. This finding provides proof-of-principle that regional transmission of seasonal respiratory viruses may complicate the interpretation of COVID-19 surveillance data. It is imperative that surveillance systems incorporate other respiratory virus testing data in order to more accurately track and forecast COVID-19 disease activity.

Genetic deficiency of Wnt5a diminishes disease severity in a murine model of rheumatoid arthritis.

BACKGROUND: Rheumatoid arthritis (RA) is a common autoimmune disease characterized by chronic inflammation of the joints, leading to bone erosion and joint dysfunction. Despite the recent successes of disease-modifying anti-rheumatic drugs (DMARDs), there is still clinical need for understanding the development and molecular etiology of RA. Wnts are developmental morphogens whose roles in adult pathology are poorly characterized. Wnt5a is a member of the non-canonical family of Wnts that modulates a wide range of cell processes, including differentiation, migration, and inflammation. Wnt5a has been implicated as a possible contributor to arthritis and it is upregulated in synovial fibroblasts from RA patients. METHODS: We investigated the role of endogenous Wnt5a in RA. Tamoxifen-inducible, Wnt5a knockout (Wnt5a cKO) mice and littermate controls were monitored for arthritis development and joint pathology using the K/BxN serum transfer-induced arthritis (STIA) model. To explore a role of Wnt5a in osteoclast fusion, bone marrow-derived monocytes (BMDMs) were differentiated in vitro. RESULTS: Wnt5a cKO mice were resistant to arthritis development compared to control littermates as assessed by ankle thickness and histologic measurements. Some parameters of inflammation were reduced in the Wnt5a cKO mice, including the extent of polymononuclear cell infiltration and extra-articular inflammation. Wnt5a cKO mice also exhibited less cartilage destruction and a reduction in osteoclast activity with concomitant reduction in tartrate-resistant acid phosphatase (TRAP), cathepsin K (CTSK), macrophage colony-stimulating factor (MCSF), matrix metalloproteinase (MMP)2 and MMP9 in the arthritic joints. Treatment of BMDMs with Wnt5a enhanced osteoclast fusion and increased the expression of dendrocyte-expressed seven transmembrane protein (DCSTAMP) and MMP9, that are necessary for osteoclast formation and activity. CONCLUSIONS: These data suggest that Wnt5a modulates the development of arthritis by promoting inflammation and osteoclast fusion, and provide the first mouse genetic evidence of a role for endogenous Wnt5a in autoimmune disease.

Knowledge of sexually transmitted infections among adolescents in the Houston area presenting for reproductive healthcare at Texas Children's Hospital.

OBJECTIVE: Studies indicate a deficiency in knowledge of sexually transmitted infections (STIs) among adolescents, yet adolescents comprise 25% of the sexually active (SA) population and account for 48% of STIs acquired annually. This survey assesses knowledge of STIs among adolescent females. The goal of this study was to assess knowledge of STIs and how it relates to safe sex behaviors and educational access. DESIGN: A confidential 10-question STI survey was administered to a convenience sample of female adolescents. Data analysis included descriptive statistics, chi-square analysis, and linear regression analysis. SETTING: Texas Children's Hospital Pediatric and Adolescent Gynecology Clinic. INTERVENTIONS: None. PARTICIPANTS: Seventy-five female participants between the ages of 10-21 years. MAIN OUTCOME MEASURES: Age, sexual activity, educational access, preferred methods of risk reduction and questions answered correctly on the STI survey. RESULTS: The mean age of participants was 14.9 ± 2.4 years; mean age of menarche was 10.9 ± 2.9 years. Based on survey responses, all adolescents demonstrated similar knowledge of specific STIs regardless of demographic factors. However, middle and late adolescent groups had increased awareness of STIs. SA participants (36%) were more likely to choose 2 or more methods of risk reduction compared to non-SA participants (P = 0.014). There was no correlation between educational access and preferred methods of risk reduction even though 92% of respondents reported receiving STI education from school, parents, or peers. CONCLUSIONS: Current efforts at STI education are not effective. Different approaches to STI education are necessary to increase knowledge and motivate adolescents to reduce high risk behaviors.

In the aftermath of the Qa'yamat: the Kashmir earthquake disaster in northern Pakistan.

This article explores the local impact of the catastrophic earthquake in northern Pakistan on 8 October 2005. Drawing on field research, including interviews with 40 earthquake survivors, the post-disaster analysis presented here focuses upon risk awareness and the reactions of respondents to the 7.6 magnitude earthquake that devastated areas of Azad Jammu and Kashmir State, and North-West Frontier Province. The analysis provides insights into local perceptions of seismic hazard and exposure as well as survivors' priorities with regard to rebuilding and reconstruction. The article suggests that the tragedy of the devastating earthquake is entangled in a deeper knot of causal factors that are social, economic and political in nature. Rapid population growth, urbanisation, changing building styles, environmental degradation and lack of preparedness and mitigation are associated with the circumstances that place the population at risk. Remarks concerning present and future risk reduction efforts are included.

The average African American male face: an anthropometric analysis.

OBJECTIVES: To determine the average facial proportions of the African American man and compare results with the neoclassical canons of facial proportions and the standard for the North American white man. DESIGN: Cross-sectional survey. METHODS: Photographs and anthropometric measurements of the face were taken of 109 men of African American descent aged between 18 and 30 years, and results were compared with the neoclassical canons of the facial proportion and the averages of the anthropometric measurements for the North American white man. Proportional relationships were calculated based on the averages. Statistical analysis was performed. RESULTS: The neoclassical canons of facial proportion were not found to be applicable to most of the African American men who participated in the study. Of the 24 anthropometric measurements obtained, 21 were significantly different from the measurements of the North American white man (P<.05). We present proportional relationships in our subjects. CONCLUSIONS: The face of the average African American man differs from the neoclassical canons of facial proportion and the averages of anthropometric measurements for the North American white man. The proportional relationships found in our subjects might serve as a template for facial analysis in this patient population.

Analysis of the African American female nose.

The African American nose has been broadly classified as ethnic yet it differs significantly in morphology from that of other ethnic groups with which it is categorized. The objectives of this study were to (1) establish an objective protocol for analysis of the African American female nose using anthropometric measurements, and (2) determine whether subjective subcategorization schemes are a reliable replacement for anthropometry. African American women (n = 107) between the ages of 18 and 30 years consented to participate in this study. Photographs and 14 standard anthropometric measurements were taken of the face and nasal region, including nose length, nose width, special upper face height, intercanthal distance, mouth width, nasal bridge inclination, nasal tip protrusion, ala thickness, nasal root width, nasal bridge length, tangential length of ala, length of columella, nasofrontal angle, and nasolabial angle. Nasal indices including nose width-nose height index, nasal tip protrusion-nose height index, and nasal tip protrusion-nasal width index were calculated. In addition, photographic analysis was performed to evaluate nostril shape, nasal base shape, and nasal dorsal height. Proportional relationships and subcategorization schemes were evaluated. A new method of nasal analysis for the African American woman uses the proportional relationships of the anthropometric measurements. Proportional relationships included a columellar to lobule ratio of 1.5:1, a nasolabial angle of 86 degrees, and an alar width to intercanthal distance ratio of 5:4. The nasal dorsal height classification scheme was the most reliable for subjective analysis. The degree of variability found within this group of young African American women is illustrated by the following indices and their respective ranges: nose width-nose height index mean, 79.7 (range, 57 to 102); nasal tip protrusion-nose height index mean, 33.8 (range, 23 to 46); and nasal tip protrusion-nose width index mean, 42.8 (range, 32 to 61). The guidelines provided are a baseline from which to begin analysis and evaluation.

Treatment of the keloid: what is new?

Keloids are benign lesions that represent an exuberant collagen response to injury. These benign lesions are plagued with high recurrence rates. Multitudes of options are available for treatment of these lesions, which supports the theory that there is no superior treatment. A variety of treatment options are discussed.