Search Results (117)

Introduction: Acute Myeloid Leukemia (AML) is a hematologic malignancy characterized by the clonal expansion of myeloid progenitors. While it primarily affects the bone marrow, extramedullary relapse occurs in 3–5% of cases, and it is linked to poor prognosis. Central nervous system (CNS) involvement presents diagnostic challenges due to nonspecific symptoms. CNS manifestations include leptomeningeal dissemination, nerve infiltration, parenchymal lesions, and myeloid sarcoma, occurring at any disease stage and frequently asymptomatic. Methods: A 62-year-old man with a recent history of AML in remission presented with diplopia and aching paresthesias in the left periorbital region spreading to the left frontal area. The diagnostic workup included neurological and hematological evaluation, lumbar puncture, brain CT, brain magnetic resonance imaging (MRI) with contrast, and dermatological evaluation with skin biopsy due to the appearance of nodular skin lesions on the abdomen and thorax. Results: Neurological evaluation showed hypoesthesia in the left mandibular region, consistent with left trigeminal nerve involvement, extending to the periorbital and frontal areas, and impaired adduction of the left eye with divergent strabismus in the primary position due to left oculomotor nerve palsy. Brain MRI showed an equivocal thickening of the left oculomotor nerve without enhancement. Cerebrospinal fluid (CSF) analysis initially showed elevated protein (47 mg/dL) with negative cytology; a repeat lumbar puncture one week later detected leukemic cells. Skin biopsy revealed cutaneous AML localization. A diagnosis of AML relapse with CNS and cutaneous localization was made. Salvage therapy with FLAG-IDA-VEN (fludarabine, cytarabine, idarubicin, venetoclax) and intrathecal methotrexate, cytarabine, and dexamethasone was started. Subsequent lumbar punctures were negative for leukemic cells. Due to high-risk status and extramedullary disease, the patient underwent allogeneic hematopoietic stem cell transplantation. Post-transplant aplasia was complicated by septic shock; the patient succumbed to an invasive fungal infection. Conclusions: This case illustrates the diagnostic complexity and poor prognosis of extramedullary AML relapse involving the CNS. Early recognition of neurological signs, including cranial nerve dysfunction, is crucial for timely diagnosis and management. Although initial investigations were negative, further analyses—including repeated CSF examinations and skin biopsy—led to the identification of leukemic involvement. Although neuroleukemiosis cannot be confirmed without nerve biopsy, the combination of clinical presentation, neuroimaging, and CSF data strongly supports the diagnosis of extramedullary relapse of AML. Multidisciplinary evaluation remains essential for detecting extramedullary relapse. Despite treatment achieving CSF clearance, the prognosis remains unfavorable, underscoring the need for vigilant clinical suspicion in hematologic patients presenting with neurological symptoms. Full article

Systemic mastocytosis (SM) is a rare and heterogeneous disorder characterized by clonal proliferation and accumulation of neoplastic mast cells in one or more organs, most commonly the bone marrow, liver, spleen, and skin. Among its clinical variants, aggressive SM (ASM) presents organ damage and debilitating symptoms due to extensive mast cell infiltration. The management of ASM remains challenging, primarily because treatment must address both symptom control and disease progression. Background/Objectives: Recent therapeutic approaches have focused on tyrosine kinase inhibitors (TKIs) that target the oncogenic KIT driver mutation, predominantly the D816V mutation, which is implicated in mast cell proliferation. We report a case series of four patients diagnosed with ASM to highlight the real-world experience in the management of ASM. All patients had confirmed KIT D816V mutations and presented with signs of advanced organ dysfunction, such as marked hepatosplenomegaly, cytopenia, and significant bone marrow infiltration. First-line therapies, including cytoreductive agents or other TKIs were used. Responses varied in these patients, and ultimately, they were initiated on or transitioned to midostaurin, a multikinase TKI. Results: All four patients, after the initiation of midostaurin, presented clinical and biological improvement—at least a clinical improvement response according to the International Working Group-Myeloproliferative Neoplasms Research and Treatment & European Competence Network on Mastocytosis (IWG-MRT-ECNM) criteria. These findings highlight the benefits of KIT inhibition in managing ASM, especially for patients with inadequate responses to traditional therapies. The impact of midostaurin on organ function, mast cell burden, and symptom control emphasizes the importance of the timely integration of TKIs into therapeutic protocols. However, optimal treatment duration, long-term safety, and the development of acquired resistance remain critical questions that warrant further studies. Larger prospective trials are needed to better delineate the prognostic factors associated with sustained response, refine patient selection, and explore combination strategies that may enhance therapeutic efficacy. Conclusions: The patients presented in this case series benefited from midostaurin therapy, showing either a clinical improvement or partial response according to the IWG-MRT-ECNM criteria. Our case series illustrates that KIT inhibitors can offer meaningful clinical benefit in ASM, reinforcing their position as an emerging cornerstone option in ASM management. Full article

Viral infections may vary from mild to severe, manifesting with a wide range of symptoms, including skin lesions, influenza-like symptoms, or meningitis/meningoencephalitis signs. Viruses that cause both skin lesions and meningitis comprise, e.g., Enteroviruses (EVs) and Herpes viruses (HV). EVs are responsible for approximately 90% of viral meningitis cases. They occur frequently among children under 3 years of age and are characterized by various types of rash. HV infections are responsible for up to 18% of viral meningitis, mostly among adults or older children. Most patients with viral meningitis recover entirely. However, the rates of serious complications and mortality may be as high as 74% and 10%, respectively, for particularly vulnerable neonatal or immunocompromised patients. Patients that present signs of encephalitis and/or are suspected to have HSV/VZV infection require immediate implementation of empiric acyclovir therapy before receiving the polymerase chain reaction (PCR) test results. The clinical picture of viral meningitis may differ depending on the virus, including the presence of both meningeal signs and skin lesions. Therefore, early identification of the etiological factor is necessary for early and proper treatment implementation. It is crucial to accurately differentiate between the causative agents, and this work focuses on answering the question of how skin lesions can assist in achieving a better and faster diagnosis. The aim of this review was to analyze the characteristics of skin lesions in the course of meningitis caused by various viral species. This can be helpful for physicians in the diagnostic process and subsequent treatment. Full article

This study investigates the virulence properties and pathogenetic characteristics of the Kazakhstani strain of LSDV (LSDV KZ-Kostanay-2018) in indigenous cattle under controlled conditions. Twelve non-breed cattle were inoculated intradermally and monitored for clinical, pathological, and immunological responses. Clinical signs, including fever, skin nodules, and lymphadenopathy, emerged as early as day 5 post-infection (pi), with peak severity observed between days 11 and 14. Rapid seroconversion was observed, with 100% of animals showing virus-neutralizing antibodies by day 13. Pathological findings revealed extensive necrosis, thrombosis, and edema, with pronounced damage in the spleen, lungs, and lymph nodes. Histological analyses identified widespread destructive changes in the dermis and systemic tissues, consistent with highly aggressive disease progression. Viral genome and replication were confirmed in blood, skin nodules, and lymph nodes, with peak viral loads between days 11 and 14 pi. These results align with findings in Russian cattle infected with the Saratov/2017 strain but demonstrate more rapid symptom onset and severe pathology, suggesting strain-specific virulence. These findings contribute to a deeper understanding of LSDV pathogenesis and underscore the importance of regional adaptations in disease management. Full article

Background/Objectives: Cutaneous manifestations can signal underlying systemic inflammation, potentially exacerbated by chronic stress and diminished well-being. While links between psychosocial factors and skin health are recognized, comprehensive data across diverse populations remain limited. This study aimed to quantify associations between self-reported stress management capabilities, sociodemographic factors (gender, age, education, urbanization, professional status), lifestyle factors indicative of well-being, and the prevalence of six common dermatological manifestations (pruritus, burning sensations, redness, rash, desquamation, sunburn) within a large Polish cohort. Methods: This cross-sectional study analyzed data from 27,000 adult participants (22,043 women, 4887 men) collected during the National Healthy Skin Test (2023) via an online questionnaire. Participants reported the frequency of dermatological symptoms, stress management practices related to skin health, and relevant lifestyle factors (indicators of well-being). Logistic regression analyses identified significant predictors for each skin manifestation. Results: Effective stress coping ability was significantly associated with a lower prevalence of all six investigated dermatological manifestations (p < 0.001 for all). Significant gender differences emerged: women reported more frequent redness and burning sensations (p < 0.001), while men reported more frequent rash, sunburn, and desquamation (p < 0.001). Younger age (18–24 years) was associated with increased rash, desquamation, and redness compared to older adults (>65 years), who reported fewer burning sensations and less pruritus. Higher education and residence in large urban centers (≥500,000 inhabitants) were associated with increased reports of specific symptoms like sunburn and redness. Conclusions: This large-scale study demonstrates a significant association between psychosocial factors, particularly self-reported stress management, and the prevalence of six common, self-reported dermatological manifestations across various sociodemographic groups in Poland. The findings underscore the potential importance of considering a biopsychosocial approach in relation to these common skin symptoms. Further research is warranted, but these results suggest that for such common, self-reported skin issues, integrating stress reduction strategies and considering sociodemographic contexts and well-being may be valuable considerations for potentially enhancing personalized patient care and warrant further clinical investigation. Full article

Background: Psoriasis is a persistent, inflammatory skin disease with autoimmune characteristics. Beyond the obvious signs of skin lesions, it has negative systemic repercussions that impair the patient’s quality of life. This study aimed to determine the effectiveness of N-acetylcysteine (NAC) alone or in combination with Vitamin E in the treatment of mild to moderate active psoriasis vulgaris. Methods: This study was an open-label, prospective, randomized, controlled interventional clinical trial conducted at Cairo Hospital for Dermatology and Venereology (Al-Haud Al-Marsoud). In total, 45 patients with mild to moderate symptoms were randomly assigned to three groups, with fifteen patients each, as follows: the control group received the standard psoriatic treatment of topical steroids and salicylic acid; the acetylcysteine group received standard psoriatic treatment in addition to NAC 600 mg per day 30 min prior to breakfast for 8 weeks; and the acetylcysteine and Vitamin E group received standard psoriatic treatment in addition to NAC 600 mg per day, in a similar way of dosing like the previous group, and Vitamin E 1000 mg per day. All participants performed a comprehensive assessment including hematological parameters, the Psoriasis Area and Severity Index (PASI), the Dermatology Life Quality Index (DLQI), malondialdehyde (MDA), and interleukin-36 gamma (IL-36γ). Results: The treatment strategy involving the use of NAC alone and in combination with Vitamin E showed significant improvement in the assessed parameters compared to the control group receiving conventional therapy. The acetylcysteine group showed improvements of 41% in PASI and 49.4% in DLQI, a decrease of 34.3% in MDA, and a decrease of 31% in IL-36γ. Similarly, the acetylcysteine and Vitamin E group showed improvements of 52% in PASI and 42% in DLQI, a decrease of 37% in MDA, and a decrease of 35% in IL-36γ. There were no significant differences found between the N-acetylcysteine and N-acetylcysteine and Vitamin E groups. Moreover, significant positive correlations were found between MDA, IL-36γ, and PASI at baseline and after the third follow-up. Conclusions: This study found promising therapeutic benefits in the addition of NAC to the conventional therapy in psoriatic patients with mild to moderate symptoms, as it significantly improved psoriasis disease outcomes and improved the patient’s quality of life. However, the addition of Vitamin E to the NAC regimen did not show additional benefits. Full article

This study explores nursing students’ stress responses while they are being trained in a mixed reality (MR) setting that replicates highly stressful clinical scenarios. Using measurements of physiological indices such as heart rate, electrodermal activity, and skin temperature, the study assesses the level of stress when the students interact with digital patients whose vital signs and symptoms interact dynamically to respond to student inputs. The simulation consists of six segments, during which critical events like hypotension and hypoxia occur, and the patient’s condition changes based on the nurse’s clinical decisions. Machine learning algorithms were then used to analyze the nurse’s physiological data and to classify different levels of stress. Among the models tested, the Stacking Classifier demonstrated the highest classification accuracy of 96.4%, outperforming both Random Forest (96.18%) and Gradient Boosting (95.35%). The results showed clear patterns of stress during the simulation segments. Statistical analysis also found significant differences in stress responses and identified key physiological markers linked to each stress level. This pioneering study demonstrates the effectiveness of MR as a training tool for healthcare professionals in high-pressured scenarios and lays the groundwork for further studies on stress management, adaptive training procedures, and real-time detection and intervention in MR-based nursing training. Full article

Background: The appearance of new clinical manifestations (for example, subcutaneous or skin abscesses) during anti-tuberculosis treatment is generally indicative of therapeutic failure. The cause of therapeutic failure may be the presence of a drug-resistant Mycobacterium infection or to the failure to achieve a sufficient concentration of the drugs in the bloodstream. Case report: Here, we report the case of a 25-year-old man suffering from tuberculosis infection with lymph-node and pulmonary involvement and an atypical response to specific therapy. Two weeks after starting four-drug antitubercular treatment, the patient began to experience fever, pain and functional impotence in the left foot and ankle, with subsequent evidence of ankle and tarsal osteomyelitis. Four weeks after starting treatment, the patient presented with several widespread, painful subcutaneous abscesses on the trunk, back and right lower limb. Drainage was performed from the ankle and from one of the abscesses, and polymerase chain reaction (PCR) showed a positive result for M. tuberculosis in both samples, with the absence of resistance to drugs. Anti-tubercular medications were continued, with resolution of the pulmonary and bone involvement but with persistence of subcutaneous abscesses, although subsequent drainages showed the absence of mycobacterium tuberculosis. Conclusions: We describe an unusual presentation of paradoxical reaction in the form of osteomyelitis and subcutaneous abscesses in an immunocompetent TB patient, and we reported other similar cases of paradoxical reactions described in the literature in the last ten years, which demonstrate the importance of considering paradoxical reactions in patients who present with new or worsening signs and symptoms after starting tuberculosis treatment. Full article

On 5 November 2020, a poisoning event involving four people by the consumption of moray eel occurred in Khanh Hoa Province, Viet Nam, with signs indicative of ciguatera. The remaining moray portion was confiscated for identification of causative species and responsible toxins. The phylogenetic study based on COX1 identified the moray as Gymnothorax javanicus Bleeker (1859). Out of 17 marine lipophilic toxins (MLPs) that were analyzed using LC-MS/MS, only Pacific ciguatoxin-1 (P-CTX-1) was detected in the moray’s flesh at 1.30 ± 0.004 ng/g ww, while no toxin was found in the skin. The N2a assay’s ciguatoxicities in the skin and flesh were 0.69 ± 0.075 and 2.49 ± 0.216 ng P-CTX-1/g ww equivalent, respectively. In the N2a assay, the P-CTX-1 amount in the moray flesh was 1.9 times greater than that determined by LC-MS/MS, indicating the presence of additional sodium channel activators or a matrix effect. The P-CTX-1 amount in the moray flesh was at a level that generates major ciguatera poisoning (CP) symptoms in humans (1.0 ng/g P-CTX-1), makes sense given that four consumers experienced the onset of poisoning symptoms. This study is significant for the management of seafood safety since it is the first scientific report on the species and toxin in a moray causing ciguatera in Viet Nam. Full article

Diabetes mellitus (DM) is a chronic metabolic disorder associated with late diagnosis due to the absence of early symptoms in patients. Cutaneous manifestations of DM often serve as indicators of insulin resistance and vary with disease progression, highlighting severity and systemic involvements. With an increasing global burden and rapidly rising prevalence, skin findings associated with DM have become more crucial for the rapid identification and treatment of underlying metabolic processes. However, current challenges in identification include inaccurate or missed detection in darker-skinned populations, which may be attributed to the lack of inclusion of diverse skin types in textbooks and research studies. This review provides clinicians with comprehensive updates on the diagnosis and treatment of cutaneous signs, complications, comorbidities, medication-associated side effects associated with DM, and the treatment of these manifestations. Full article

Canine demodicosis is a contagious skin disease caused by the over-proliferation of Demodex mites in the host’s hair follicles. This study examines the prevalence, clinical signs, and hematological changes associated with demodicosis in street dogs of Rupandehi, Nepal. Between August 2023 and January 2024, 100 skin scrapings were collected from each street dog presenting dermatological symptoms. The samples, treated with 10% KOH and microscopically examined, revealed a 21% positivity rate for demodicosis, with all cases involving Demodex canis. The infection predominantly affected young puppies (37.5%), females (21.6%), mixed breeds (33.3%), and dogs with above-ideal body conditions (25%). There was no significant association between infection and variables such as age, gender, breed, or nutritional status. Clinically, all affected dogs exhibited alopecia, primarily on the legs. Hematological assessments indicated significant increases in neutrophils and eosinophils and a notable decrease in mean corpuscular hemoglobin concentration and lymphocytes among infected dogs (p < 0.05). This study underscores the importance of vigilant monitoring and comprehensive diagnostic practices in effectively managing and treating canine demodicosis, especially in street dogs. Full article

The study investigated the determinants of safe pesticide handling and application among farmers in rural communities of Oyo State, ssouthwestern Nigeria. A cross-sectional design utilizing 2-stage cluster sampling techniques was used to select Ido and Ibarapa central Local Government Areas and to interview 383 farmers via a structured questionnaire. Data were analyzed using descriptive statistics and logistic regression at p = 0.05. Results showed that 41.8% of the farmers had been working with pesticides on farms for at least 5 years, 33.0% attended training on pesticide application, 73.5% had good safety and health knowledge, and 72.3% had safe pesticide handling and application practices. About half (50.2%) stated that they wear coveralls, gloves, and masks to protect their body, face, and hands when applying pesticides, 9.8% use empty pesticide containers for other purposes in the house/farm, while 11.5% blow the nozzle with their mouth to unclog it if it becomes blocked. The three major health symptoms reported by the participants were skin irritation (65.0%), itchy eyes (51.3%), and excessive sweating (32.5%). Having attended training on pesticide application and use enhanced (OR = 2.821; C.I = 1.513–5.261) practicing safe pesticide handling and application. Farmers with good knowledge (OR = 5.494; C.I = 3.385–8.919) were more likely to practice safe pesticide handling and application than those with poor knowledge about pesticide use. It is essential to develop and deliver mandatory comprehensive training programs for farmers on impacts of pesticides on health and environment, along with sustainable safe handling, application, and disposal of pesticides using proper waste management techniques and recognizing early signs and seeking medical assistance. The urgent need to strengthen policy to regulate pesticide use and limit farmers’ access to banned products is also key. Full article

Can black soldier fly (BSF) larvae be a protein substitute for managing adverse food reactions (AFRs) in dogs, specifically those with dermatitis? We evaluated BSF larvae’s safety, tolerance, and effectiveness as a novel protein source in dogs with AFRs. Sixteen dogs, including eight healthy controls and eight diagnosed with AFRs, were fed a diet containing BSF larvae for four weeks. Skin conditions, including dermatological lesions and Pruritus Visual Analog Scale (PVAS) scores, and gastrointestinal signs, including relevant clinical signs, stool consistency, and hematological and biochemical parameters, were monitored. No significant gastrointestinal side effects were observed. The control and AFRs groups maintained stable body weights, while stool consistency scores did not change significantly. Moreover, skin reaction data obtained before the study were collected through interviews with the owners. The mean PVAS scores in the AFRs group were significantly higher (p < 0.05) during the self-control period (6.0 ± 1.6) when compared with other periods. However, no significant differences (p > 0.05) were observed between the pre-study baseline (2.0 ± 1.1) and scores at 2 weeks (2.3 ± 1.5) and 4 weeks (2.4 ± 1.2) of feeding with BSF-based food, which indicated that BSF larvae did not exacerbate pruritic symptoms. Hematology and blood chemistry remained within normal ranges in all dogs, indicating no adverse effects on overall health. BSF larvae were well tolerated by AFR-affected and control dogs, with no adverse clinical outcomes. The findings suggest that BSF larvae may offer a better, sustainable alternative protein source for managing AFRs in dogs, particularly in those on hypoallergenic diets. Further long-term studies are needed to confirm these results and assess the broader implications of BSF larvae diets on canine health. Full article

The interplay between nutrition and skin health provides a crucial lens for understanding, diagnosing, and managing eating disorders (EDs) such as anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED). This review explores the dermatological manifestations resulting from the nutritional deficiencies commonly associated with EDs, including conditions like hair loss, xerosis, and brittle nails. These changes in the skin and its appendages often reflect deeper systemic dysfunctions, such as deficiencies in essential micronutrients (zinc, iron, and vitamins A and C), hormonal imbalances, and electrolyte disturbances. Recognizing these dermatological signs as diagnostic tools is vital for the early identification and intervention of EDs. By integrating dermatological observations with psychiatric and nutritional care, a holistic, multidisciplinary approach can be developed to address both the physical and psychological complexities of EDs. This review highlights the critical role of these skin-related markers in promoting timely diagnosis and effective treatment. To examine the relationship between specific nutrients and dermatological manifestations in EDs, a systematic review of three electronic databases—PubMed, Google Scholar, and ResearchGate—was conducted. The findings underline the importance of early recognition of these skin symptoms for effective management. Collaborative care involving dermatologists, psychiatrists, and nutritionists is essential for diagnosing and treating EDs. Such integrated efforts ensure a comprehensive approach to these multifaceted conditions, ultimately improving patient outcomes and enhancing overall care. Full article

Background: Lumpy skin disease virus (Poxviridae family—Capripoxvirus genus) is the aetiological agent of LSD, a disease primarily transmitted by hematophagous biting, affecting principally cattle. Currently, only live attenuated vaccines are commercially available, but their use is limited to endemic areas. There is a need for safer vaccines, especially in LSD-free countries. This research aims to develop and test a safe and efficacious inactivated vaccine. Moreover, in this study, we used keyhole limpet hemocyanin (KLH) as a positive marker to distinguish infected from vaccinated animals (DIVA). Methods: Lumpy skin disease virus was propagated on primary lamb testis cells and Madin–Darby bovine kidney cells (PLT and MDBK, respectively), and four inactivated vaccines were produced. The vaccines differed from each other with the addition or not of KLH and in cells used for virus propagation. To evaluate the safety and immunogenicity, the vaccines and two placebos were administered to six groups comprising six male calves each, and antibody response was investigated using both an enzyme-linked immunosorbent assay (ELISA) and a serum neutralization (SN) test. In addition, the LSD/γ-interferon test and KLH (IgM-IgG) ELISA were performed on the collected samples. Furthermore, the use of KLH allowed us to distinguish vaccinated animals in the ELISA results, without any interference on the strength of the immune response against the LSDV. Finally, the efficacy of one of four vaccines was investigated through a challenge, in which one group of vaccinated animals and one animal control group were infected with a live field strain of LSDV. Results: Four out of the six control animals showed severe clinical signs suggestive of LSD, and, therefore, were euthanized for overcoming the predetermined limit of clinical score. By contrast, the vaccinated animals showed only mild symptoms, suggesting a reduction in severe disease notwithstanding the incapability of the vaccine in reducing the virus shedding. Conclusion: The vaccines produced were safe and able to elicit both a humoral and a cellular immune response, characteristics that, together with the demonstrated efficacy, make our vaccine a good candidate for countering the LSD spread in disease-free countries, thus also facilitating disease containment throughout the application of a DIVA strategy. Full article