The use of lasers in vitiligo, an overview Post, N.F.; Ezekwe, N.; Narayan, V.S. ...
JEADV. Journal of the European Academy of Dermatology and Venereology/Journal of the European Academy of Dermatology and Venereology,
June 2022, Letnik:
36, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Various types of lasers have been demonstrated to be effective in the treatment of vitiligo. The mode of action of these lasers is just as varied as the purpose of intervention. Many clinicians are ...not aware of the unique opportunity these lasers offer to improve the outcomes of vitiligo treatment. To date, no clear overview exists of the use of lasers in vitiligo treatment. Thus, the aim of this review is to discuss the various types of lasers and provide an overview of the evidence for their efficacy. We found good evidence from a systematic review that the excimer laser is effective, induces repigmentation rates comparable to NB‐UVB and has improved outcomes when combined with calcineurin inhibitors. Ablative lasers are commonly used for tissue graft or melanocyte–keratinocyte cell graft transplantation. They provide safe, fast and uniform denudation of the epidermis with propitious repigmentation outcomes. We found conflicting evidence from two systematic reviews regarding the efficacy of fractional ablative lasers for improving outcomes of NB‐UVB therapy, a systematic review including only fractional ablative lasers provided evidence for efficacy. Q‐switched nanosecond lasers have shown to be safe and effective for inducing depigmentation, although recurrence is common, and most studies were small and retrospective. Despite proven efficacy and safety, laser treatments are relatively expensive and suited for limited body surface areas and selected cases. Each type of laser has benefits and risks associated and should, therefore, be individually chosen based on location, extent, activity and type of vitiligo.
The Ivo River Basin of south-eastern Nigeria is a water scarce and mining region, which suffers from water scarcity. The influence of mining activities on the quality of the Ivo River and its ...capacity for community water supply was investigated. Also the efficacy of TDS-Eh graph in explaining water quality was presented. Results indicated that the TDS-Eh graph highlights subtle chemical relationships which control water quality and provide a simple but generic pollution index for rapid water quality assessment. It was also discovered that the Ivo River could become an adequate alternative to groundwater as a source of rural water supply in the study area with an estimated average daily discharge of 6726000L and a rural population of less than 200000 persons. The Ivo River meets the WHO drinking water standards in 20 physico- chemical water quality parameters （pH, temperature, conductivity, turbidity, salinity, TDS, Eh, alkalinity, chloride, nitrate, sulfate, phosphate, calcium, magnesium, iron, manganese, zinc, lead and cadmium） analyzed and can therefore （with little treatment） provide up to 133.4% of average community water demand and 83.8% of maximum community water demand. The. impact of mining on Ivo River quality was found to have been moderated by the presence of carbonate rocks which may have enhanced the precipitation of heavy metals from the river.
Self-inflicted burns (SIBs) are preventable injuries that often occur due to suicidal intent or deliberate self-harm. The incidence of SIB and demographics vary across different countries. This study ...highlights our regional experience of SIB over almost 2 decades, assessing characteristics and outcomes. A retrospective chart review of all patients assessed at a UK regional burns center, presenting with SIB, from 2003 to 2021, was performed. Subgroup analyses based on gender, the presence or absence of pre-existing psychiatric disorders, and in-hospital patient mortality were undertaken. The relationship between annual mental health funding and the incidence of SIB was assessed. Over the study period, a total of 285 SIB cases, with a median age of 42.84 years, were presented to our center. The majority of patients were male (63.2%) and had a pre-existing psychiatric disorder (74.7%). Flame burns were the most frequent type of injury (82.1%) and the median total BSA (TBSA) was 10.25%. The average length of hospital stay was 10 days and the inpatient mortality rate was 20.7%, significantly greater than the mortality of the rest of the cohort (3.7%, P < .01). SIB survivors were younger and had less severe burns, relative to non-survivors. There was no statistically significant correlation between the incidence of SIBs and mental health funding. SIBs account for a minority of referrals to our regional burns center. Adequately funded regional and national measures should be implemented to reduce the incidence and impact of these injuries, alongside appropriate mental health support.
Polyps <1 cm are the most commonly found polyps during colonoscopy. Cold snare removal is preferred given the significantly higher rate of incomplete resection associated with piecemeal biopsy ...forceps resection. There are currently no standardized tools to assess competence in cold snare polypectomy. This study aimed to develop and validate a cold snare polypectomy assessment tool (CSPAT).
Experts in cold snare polypectomy used a Delphi method to develop the CSPAT. Metrics with a greater than 85% agreement as being “important” or “very important” were included in the CSPAT. The tool included evaluation of polyp inspection, positioning, appropriate ensnarement of tissue to ensure a rim of normal tissue, tissue retrieval, and postpolypectomy site inspection. Experts in cold snare polypectomy used the CSPAT to evaluate preselected videos that were previously evaluated using the Direct Observation of Polypectomy Skills (DOPyS) tool. Interobserver agreement was evaluated. CSPAT scores were compared with DOPyS scores to assess content validity.
Sixteen experts developed the 12-item CSPAT, and 13 experts reviewed 55 videos. There was a moderate degree of agreement in 10 metrics (κ = .52-.59) and a substantial degree of agreement (κ = .61-.63) in the other 2. There was a strong correlation between the mean of individual metrics 1 to 12 compared with the global competence assessment (ρ = .88, P < .001). There was a moderate correlation between the average overall DOPyS score and the overall CSPAT competence score (ρ = .56, P < .001).
We have developed and validated a customized CSPAT that can be easily applied to video-based assessments to assess competence in training and among practicing endoscopists.
Abstract
Dermal substitutes are well established in the reconstructive ladder. MatriDerm® (Dr. Otto Suwelack Skin & Health Care AG, Billerbeck, Germany) is a single-layer dermal substitute composed ...of a bovine collagen (type I, III, and V) and elastin hydrolysate, that allows for immediate split-thickness skin grafting (SSG). The aim of this study was to histologically characterize the integration of MatriDerm® when used during burns surgery reconstruction. Eight subjects with nine burn scars and one acute burn wound underwent reconstruction with MatriDerm® and an immediate SSG. MatriDerm® integration and skin graft take were assessed with serial biopsies performed at weeks 1, 2, 3, and 4 and months 2, 3, 6, 9, and 12. Biopsies were assessed with standard special stains and immunohistochemistry, and representative slides were imaged with a transmission electron microscope. Patient satisfaction and clinical scar outcome were assessed with the Vancouver Scar Scale and a patient questionnaire. Histological analysis showed similar stages of wound healing as shown in other dermal templates but on a different timescale. There is early evidence of vascularization and an inflammatory infiltrate in the first 2 weeks. MatriDerm® is resorbed earlier than other dermal substitutes, with evidence of resorption at week 3, to be completely replaced by a neodermis at 2 months. The use of MatriDerm® in reconstruction with immediate skin grafting is supported histologically with early evidence of vascularization to support an epidermal autograft. Future histological studies may help further characterize the ideal dermal substitute.
Unusual occurrence of mental-related illnesses has been reported in the Ishiagu mining area of South Eastern Nigeria and this may be related to the long-term consumption of heavy metal-contaminated ...groundwater. Groundwater from 27 domestic water sources (mainly open hand dug wells and springs) was therefore sampled within two seasons and analyzed for both physical and chemical parameters. Results were compared with international standards for drinking water and also subjected to factor analysis. The analysis showed that iron has the highest concentration of heavy metals exceeding the WHO-permitted desirable limit of 0.3 mg/l in about 73% of cases. Manganese was ubiquitous in groundwater samples exceeding the EU-permitted limits in about 41% of cases. Zinc, although within acceptable international limits was also common in samples from the Ishiagu central area, the Ayaragu, and the Amaubiri-Lokpauku axis. Lead and cadmium occurred in 3 and 13% of cases, respectively, and was outside international regulatory standards for drinking water. Long-term exposure to manganese and cadmium may therefore be a significant cause of the prevalence of mental related illness in the study area. There is also the possibility of impacts from other elements previously undetected in the groundwater system of the study area (but revealed through factor analysis) including arsenic, vanadium, bromine and fluorite (ide) and this needs urgent investigation. Major factors affecting groundwater quality included mineral dissolution and polluted discharge/recharge from mining operations.
Limited data exist regarding patient-reported outcomes and quality of life (QOL) experienced by patients with Barrett's esophagus (BE) referred for endoscopic eradication therapy (EET). Specifically, ...the impact of grade of dysplasia has not been explored. The purpose of this study is to measure patient-reported symptoms and QOL and identify factors associated with poor QOL in BE patients referred for EET. This was a prospective multicenter study conducted from January 2015 to October 2017, which included patients with BE referred for EET. Participants completed a set of validated questionnaires to measure QOL, symptom severity, and psychosocial factors. The primary outcome was poor QOL defined by a PROMIS score >12. Multivariable logistic regression analysis was performed to identify factors associated with poor QOL. In total, 193 patients participated (mean age 64.6 years, BE length 5.5 cm, 82% males, 92% Caucasians) with poor QOL reported in 104 (53.9%) participants. On univariate analysis, patients with poor QOL had lower use of twice daily proton pump inhibitor use (61.5% vs. 86.5%, P = 0.03), shorter disease duration (4.9 vs. 5.9 years, P = 0.04) and progressive increase in grade of dysplasia (high-grade dysplasia: 68.8% vs. 31.3%, esophageal adenocarcinoma: 75.5% vs. 24.5%, P < 0.001). Multivariate analysis demonstrated that high-grade dysplasia was independently associated with poor QOL (OR: 5.57, 95% CI: 1.05, 29.5, P = 0.04). In summary, poor QOL is experienced by the majority of patients with BE referred for EET and the degree of dysplasia was independently associated with poor QOL, which emphasizes the need to incorporate patient-centered outcomes when studying treatment of BE-related dysplasia.
The effect of including palm oil sludge in cattle diet (silage) was conducted in vitro in order to ascertain the suppressing effect on ruminal methanogenesis. The silage used for the study was ...Panicum maximum, Centrocema pubscens, Bracharia decumbens and Andropogon gayanus. The silage were cut into an average size of 3 to 5 cm and ensiled for 21 days. Four treatment diets were formulated with the silage by including palm oil sludge at 0, 10, 20 and 30%, respectively. Treatments were subjected to anaerobic digestion in 10 L bio-digesters. Total gas production, percentage methane production, volatile fatty acids and microbial population of the substrate were measured. Total gas production was significantly suppressed in the treatment having 30% palm oil sludge for about 25 days while a lag phase of 16 days was observed before a significant amount of methane was detected. Acetic acid production increased only in T1 on the first week while T2, T3 and T4 decreased after which their production remained irregular until the end of the experiment. Propionic acid production also increased in T1 and T4 on the first week while T2 and T3 decreased after which their production maintained an undefined pattern as the experiment progressed. Butyric acid production increased in T1, T2, and T4 on the first week while T2 decreased after which an undefined trend of production was established. Microbial population especially methanogens also reached its peak around the same period when there was maximum gas production. It was concluded that ruminal methanogenesis can be suppressed in-vitro by the inclusion of 30% palm oil sludge in the silage.
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