Unveiling the Enigma: Exploring capsular contracture-Unraveling its link with autoimmune disorders and comprehensive examination of predisposing factors.

Introduction: Breast augmentation, a popular cosmetic surgery using devices like silicone implants, can lead to a common issue called capsular contracture (CC). This condition involves the formation of fibrous tissue around the implants and can be influenced by variables like immunological and bacterial factors. This study aimed to explore the impact of autoimmune diseases (ADs) on CC along with other factors influencing future clinical decisions. Methods: A systematic review of electronic databases was conducted using PubMed, Web of Science, Scopus, EMBASE, and involving adult patients (>18) with CC and ADs after breast surgery using MeSH terminology using a broad search strategy. All searches were performed and analyzed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and duplicates were removed with Rayyan. Two independent investigators extracted and assessed the data involving demographics and baseline data related to CC and AD. Results: The incidence of CC varied (2.3%-4.1%). Subglandular placement and older device age raised risk. SERI Surgical Scaffold complications included necrosis, seroma, hematoma, implant loss, and infection; CC was associated with necrosis. Natrelle 410 implants showed lower 10-year CC risk than round gel implants. Acellular dermal matrix implant-based breast reconstruction with radiotherapy (RT) correlated with 20.7% post-RT CC. Previous research demonstrated no significant connection between silicone gel implants and ADs. Biofilm, surgical site infection, implant features, and interventions emerged as frequent CC risk factors. Conclusion: Finding appropriate techniques to reduce the risk factors associated with CC together with providing comprehensive patient counseling on these factors will definitely improve the patient-centered outcome of breast implant surgery.

Early Diagnosis of Autism Spectrum Disorder: A Review and Analysis of the Risks and Benefits.

Autism spectrum disorder (ASD) is a neurodevelopmental condition made up of enduring challenges in social communication and interaction and the presence of repetitive and restricted behavior patterns. Early diagnosis of autism is crucial for timely intervention and improved long-term outcomes. This review aims to explore some of its signs and symptoms, look into some diagnostic tools, and analyze the benefits and risks associated with an early diagnosis of autism. The symptoms of ASD vary from child to child, some of which are: avoidance of eye contact, lack of response to names, excessive fear, and lack of interactive and pretend play. Early identification of these symptoms by caregivers and healthcare providers facilitates the need for diagnosis and appropriate interventions. Some screening and diagnostic tools that have been found to help make the diagnosis are the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F), the Social Communication Questionnaire (SCQ), the Parents' Evaluation of Developmental Status (PEDS), and the Childhood Autism Rating Scale (CARS), amongst others. The benefits of early diagnosis include the opportunity for early intervention, which has been shown to enhance developmental outcomes and improve adaptive skills. Early identification allows for the implementation of specialized interventions tailored to the specific needs of individuals with autism, targeting social communication, language development, and behavioral challenges. Furthermore, early diagnosis enables families to access appropriate support services, educational resources, and community programs, facilitating better coping mechanisms, reducing parental stress, and increasing adult independence. However, early diagnosis of autism also entails certain risks. One significant concern is the potential for labeling and stigmatization, which can impact the child's self-esteem and social interactions. There is a risk of overdiagnosis or misdiagnosis, leading to unnecessary interventions and treatments. Additionally, the diagnostic process can be lengthy, complex, and emotionally challenging for families, requiring comprehensive assessments by multidisciplinary teams. This review highlights the importance of a balanced approach when considering the benefits and risks of early diagnosis. Early identification allows for timely interventions that significantly improve developmental outcomes and quality of life for individuals with autism. To mitigate the risks, it is crucial to ensure accurate and reliable diagnostic procedures, support families throughout the process, and promote societal awareness and acceptance. We also highlighted some future directions in the management of autism, including the use of biomarkers and the use of artificial intelligence and learning for diagnosing ASD.

Pyoderma Gangrenosum Precipitated by Breast Engorgement Following Lactation Discontinuation: A Rare Case Report.

Pyoderma gangrenosum (PG) is an inflammatory disease characterized by recurrent painful ulcers, eventually leading to cribriform scars. PG is mostly a diagnosis of exclusion with neutrophilic skin infiltration. We present a case of a 35-year-old female patient whose first presentation of PG occurred in the first trimester of pregnancy, which recurred after discontinuation of breastfeeding. The patient also had a history of taking prolonged IM and IV analgesics for her chronic migraines. The patient was initially treated with steroids and necessary wound care, during which symptoms remained controlled. However, a year later, the patient presented with an acute flare-up of the disease in her postpartum period, mainly involving her breasts bilaterally. Extensive wound debridement was performed due to the severity of her necrotic ulcers and failure to respond to conservative management, which was followed by partial thickness skin grafting.

Clinical characteristics and outcomes of patients with Herpes Zoster Infection in the context of SARS-CoV-2 infection. A case report and a systematic review.

INTRODUCTION: Severe acute respiratory syndrome-coronavirus 2 (SARSCoV2) pandemic has been an unceasing plight with a wide range of clinical presentations. The direct effects of the virus, increased use of medications, and lifestyle changes have contributed to the vulnerability to co-infections. Fungal and bacterial co-infections led to increased morbidity and mortality during the pandemic. Similarly, the surge of skin signs in conjunction with herpes zoster (HZ) manifestations has been reported. In this study, we pooled the data on the clinical characteristics of SARS-CoV-2 patients co-infected with HZ. METHODOLOGY: Electronic databases including PubMed, Scopus, and Google Scholar were extensively searched to identify the relevant studies on HZ infection among the SARS-CoV-2 patients. RESULTS: A total of 79 patients (from case reports, series, and retrospective studies) were included in the analysis. Fever was the most common constitutional symptom recorded, followed by cough and dyspnea. A systemic rash was reported in 78.5% of cases with mild symptoms of HZ and SARS-CoV-2 in 87% and 76%, respectively. Only 19% of the cases presented during the prodrome period of SARS-CoV-2. HZV polymerase chain reaction (PCR) was positive in 8.9% of the cases, and the remaining were diagnosed clinically. SARS-CoV-2 PCR was reported positive in 65 cases (82.3%). Leukopenia was observed in 7 cases (8.9%) and lymphopenia in 25 (31.6%). All patients recovered through conservative treatment. CONCLUSION: SARS-CoV-2 escalated the incidence of HZ reactivation. Most of the patients were seen with older individuals either simultaneously or a few days after the SARS-CoV-2 infection, but a few cases were reported during the asymptomatic prodrome period of SARS-CoV-2.

Advantages and Disadvantages of Using St. John's Wort as a Treatment for Depression.

BACKGROUND AND OBJECTIVES: St. John's wort (SJW) extracts are currently being used to treat depression of various degrees of severity. While many studies have shown it to be superior to placebo, data regarding the effectiveness of using SJW as a stand-alone treatment compared with standard antidepressants has yet to be proven conclusively. This study aims to understand the advantages and disadvantages of SJW as a treatment modality for depression. METHODS:  The authors searched PubMed, JAMA network, Springer Link, Elsevier, Google Scholar, and Scientific Progress databases, from 2011 through August 2021, using the following keywords: St John's wort, Hypericum perforatum, depression, antidepressant, complementary alternative medicine, economic evaluation depression St. wort, St John's wort and depression, antidepressant interactions. This yielded a total of 27 papers following a thorough removal of irrelevant content and dissemination in languages other than English. RESULTS:  In patients with mild and moderate depression, SJW proved superior to placebo. Certain studies comparing the efficacy of SJW versus selective serotonin reuptake inhibitors (SSRIs), especially fluoxetine, reported SJW to be more efficacious, while the majority reported no significant difference. Tricyclic antidepressants were also found to have similar efficacy as SJW. Moreover, treatment with SJW was also found to reduce postmenopausal depression. Regarding the safety profile, although SJW is better tolerated with fewer adverse effects when compared to standardized antidepressants, its predisposition to causing fatal serotonin syndrome, when used in conjunction with other serotonergic agents and drug interactions noted with CYP 450 drugs, raises a question in the safety profile. CONCLUSION:  It is essential to acknowledge that SJW has been used as a treatment measure in Germany. Despite being only listed as a dietary supplement by the FDA and not a drug, SJW has shown to be comparable, if not more efficacious, than most standard treatment options for depression. SJW does prove to be an exciting piece of pharmacotherapy in the realm of mental health and post-menopausal treatment. More prospective studies will help us better understand its efficacy in mild and moderate depression and its ability to serve as a long-term agent. Considering its mechanism of action, its role in relieving patients suffering from an anxiety disorder is also worth considering.

Use of Dupilumab in Glucocorticoid-Dependent Asthma.

Of the patients with asthma, 20% to 25% progress to severe symptoms, resulting in poor quality of life and increased episodes of exacerbation. There is a broad range of drugs used for asthma; the most used medications for severe asthma are inhaled glucocorticoids with or without long-acting ß-agonists. Systemic glucocorticoids and other treatments as add-on therapies are also given as needed. Chronic glucocorticoid use is associated with numerous adverse effects, including diabetes mellitus, osteoporosis, anxiety, depression, and cataracts. The occurrence of these side effects has been reduced because of the emergence of new biological therapies. One such treatment is dupilumab, which helps in the reduction of type 2 inflammation involved in the pathophysiology of asthma. We conducted a literature review to assess the efficacy, adverse effects, and pharmacological benefits of dupilumab in glucocorticoid-dependent asthma. In most randomized controlled trials, dupilumab has shown significant efficacy and safety profile in patients with severe asthma with corticosteroid dependence. Associated adverse effects such as injection site reaction and transient eosinophilia have been reported. Our review of the literature indicates that dupilumab has proven to improve lung function, reduce the rate of asthma exacerbations, and reduce the use of corticosteroids.

Portal vein thrombosis as a thrombotic complication of COVID-19 mRNA vaccine: A case report and literature review.

Thrombosis following COVID-19 vaccination commonly occurs with vector-based vaccines. The proposed mechanism is vaccine-induced thrombotic thrombocytopenia (VITT), with thrombocytopenia as principal manifestation. We present a 51-year-old male who came with isolated portal vein thrombosis (PVT) one day after Moderna vaccination, without associated thrombocytopenia, challenging VITT as being the only patho-mechanism. Further exploration of these possible alternative mechanisms is needed for COVID-19 vaccine-related thrombotic complications.

Challenges in Providing Reproductive and Gynecologic Care to Women With Intellectual Disabilities: A Review of Existing Literature.

Objective: Our review aims to focus on identifying challenges faced by intellectually disabled women (IDW) in receiving gynecological and reproductive care and also highlights evidence based strategies to overcome those challenges. Materials and methods: We conducted a literature review discussing challenges faced by IDW in obtaining healthcare services by thorough search on various electronic databases (PubMed, Google Scholar, and Scopus) starting from 2000 to 28 August 2021 excluding all non-english articles, reviews, editorials and letters to editor. The keywords used for search were "reproductive care", "gynecologic care", "intellectual disability", "mental handicap", and "mental retardation". Results: The existing literature review showed that IDW have difficulty maintaining menstrual hygiene and lack knowledge regarding contraception use and sexual health resulting in violations of their reproductive rights. Sexually transmitted diseases and cervical cancer are common among IDW due to their vulnerability to sexual abuse. Nulliparity in IDW increases their suspectibility to even breast cancer. Moreover, they face problems with sexually transmitted infection (STI) and cancer screening due to physical barriers for assessment, low socio-economic status, physician-patient communication issues and deficit in skilled providers. Short acting sedatives such as ketamine or midazolam can be used to overcome challenges faced with gynecological and obstetric examination. Finally forced sterilization and institutionalization has been a habitual practice as menstrual hygiene and pregnancy in IDW raise concerns on psychosocial challenges along with associated obstetric complications. Conclusion: Reproductive and sexual health education including contraception use can be provided by using evidence based strategies involving use of pictures, animations and models by adequately trained healthcare providers including midwives. Further research involving IDW is needed to allow state-wise laws and policies to be created to mitigate the challenges and improve health outcomes in this population.