Estimating the potential public health and economic impact of vaccination strategies with an adapted vaccine in Colombia using a combined Markov-decision tree model

BACKGROUND

Using adapted COVID-19 vaccines targeting current variants in circulation is necessary for addressing the dynamic evolution of the SARS-CoV-2 virus and protecting against emerging variants. This study evaluated the impact of various vaccination strategies with an adapted vaccine in Colombia.

RESEARCH DESIGN AND METHODS

Using a previously published combined Markov-decision tree model adapted for the Colombia context, this study estimated the outcomes of different vaccination strategies targeting various age and risk groups. The model used age-specific epidemiology, clinical, cost, and quality of life inputs derived from the published literature and national surveillance data. Scenario and sensitivity analyses were conducted to assess uncertainty.

RESULTS

Compared to no vaccination, the vaccination strategy targeting older adults aged ≥65 years and the high-risk population was estimated to prevent 306,460 symptomatic cases, 5,200 hospitalizations, 3,381 deaths, and 39,454 lost QALYs, translating to total direct and societal cost savings of USD 70,840,305 and USD 128,918,995, respectively. These gains were further increased by expanding vaccination to additional age groups. Results were most sensitive to parameters for the attack rate and duration of protection.

CONCLUSIONS

Implementing vaccination strategies targeting a broader age range with an adapted vaccine would result in considerable health and economic benefits in Colombia.

Portable SERS for salivary-based detection of oral pre-malignant lesions and carcinomas: a step toward clinical implementation

The rising incidence of oral cancer has emerged as a serious menace to our civilization. Modern dietary habits, lack of awareness, and delays in early detection are major contributing factors to the global spread of this issue. This work reports the promising findings for diagnostic accuracy of oral cancer in pre-malignant stages by analyzing surface enhanced Raman spectroscopy (SERS) profiles of different stages of oral cancer combined with multivariate analysis. Using 99 clinical samples from which 39 samples were from malignant stage, 28 from pre-malignant and 32 from healthy controls, SERS analysis was carried out by employing label-free silver nanorods as SERS substrates. The SERS spectra of malignant and pre-malignant samples manifest distinct peaks associated with varying concentrations of inorganic metabolites and proteins. Primarily, the elevated level of thiocyanate dominates the SERS spectra in malignant samples while antioxidants like uric acid, xanthine and hypoxanthine's are the key elements in the pre-malignant samples. A ratio-metric analysis of 2130 and 1435 cm-1 peak revealed that the pre-malignant lesions consistently lie between 2 and 3, whereas malignant samples have ratio greater than 3 due to higher intensity of thiocyanate peak. The multivariate analysis successfully separates between oral cancer positive and negative samples with a sensitivity and specificity of 93.5 and 92.7 % respectively. This study presents promising results for the early detection of oral cancer, which could assist clinicians in saving lives.

Did Economic Evaluations on Pharmaceuticals and Vaccination for COVID-19 Maintain Adequate Reporting Quality? A Systematic Review and Quantitative Analysis

AIM

This study seeks to assess the reporting quality of published health economic evaluations (HEEs) on vaccination and pharmaceuticals for Coronavirus Disease 2019 (COVID-19), and identify potential predictors associated with reporting quality.

METHODS

A systematic literature search was performed in PubMed, Web of Science, Embase, the Cochrane Library, INAHTA, and Chinese databases (e.g., SinoMed, CNKI, and WANGFANG Database). HEEs published between January 1, 2020, and August 20, 2022, that considered both costs and outcomes of vaccination and pharmaceuticals for COVID-19 were included. The Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement scored the reporting quality for incorporated studies. A linear regression analysis was employed to characterize the impact of various features on reporting quality.

RESULTS

Fifty-two studies were included in the analysis. The average CHEERS score was 18.54±3.41, with the scoring rate of reporting quality was 67% (±12%). The most inadequately reported items included health economic analysis plan, time horizon, valuation of outcomes, heterogeneity, uncertainty, distributional effects, and stakeholder involvement. Higher reporting compliance was associated with articles applying a longer time horizon (no less than 1 year) and those using a societal perspective (p < 0.05). The investigations that did not specify a study perspective received the lowest scores among the subgroups.

CONCLUSION

Overall, the included HEEs on vaccination and pharmaceuticals for COVID-19 had moderate reporting quality. Future HEEs should be transparently and sufficiently reported in accordance with standard guidelines (e.g., the CHEERS 2022 statement), to increase the interpretability of results, improve the reporting quality, and better inform the decision-making.

Mohs Micrographic Surgery Versus Wide Local Excision in the Treatment of Anogenital Squamous Cell Carcinoma: A Systematic Review

Primary anogenital squamous cell carcinoma (SCC) is a locally aggressive malignancy that requires careful consideration of surgical margins. Anogenital SCC impacts the quality of life due to tissue removal, scarring, and sexual dysfunction. Mohs micrographic surgery (MMS) offers a compelling alternative to wide local excision (WLE) due to its complete margin control and potential tissue-sparing properties. This analysis systematically reviews surgical modalities used for the management of anogenital SCC. Articles meeting eligibility criteria were identified using MEDLINE (via PubMed), Embase, Cochrane, and Scopus databases. All studies investigating surgical management of anogenital SCC with WLE (including vulvectomy) or MMS were considered. A total of 70 studies met inclusion criteria: 46 examined WLE patients, 8 utilized vulvectomy, and 24 examined MMS patients. MMS patients experienced lower local recurrence rates; regional and distant recurrence rates did not differ. The local, regional, and distant recurrence rates for WLE were 17.7%, 5.1%, and 6.0%, respectively, and 5.0%, 3.8%, and 4.3% for MMS. Local recurrence was more likely in patients treated with WLE (p < 0.0001). No differences were noted in regional recurrence (p = 0.444) and distant recurrence (p = 0.420). Study limitations include differences in tumor characteristics and follow-up durations between the groups. The WLE group had larger tumors at presentation. Overall, MMS had superior outcomes for local recurrence compared to WLE and vulvectomy, making it a reasonable option for managing anogenital SCC.

A case of congenital heart defects and familial exudative vitreoretinopathy caused by activation of a cryptic splice donor in NOTCH1

BACKGROUND

NOTCH1 is associated with two disorders of vascular development, Adams-Oliver Syndrome 5 (AOS5) and aortic valve disease 1 (AOVD1). Here we report a disease-causing variant in NOTCH1 that has a previously undemonstrated effect on splicing. Additionally, we found that the proband has the optic phenotype of familial exudative vitreoretinopathy (FEVR) which has been reported for probands with pathogenic variants in genes in the notch signaling pathway, but never for NOTCH1.

CASE PRESENTATION

The proband presented with a ventricular septal defect, pulmonic stenosis, and ocular findings consistent with familial exudative vitreoretinopathy (FEVR), which NOTCH1 has not been associated with to date. Trio exome sequencing identified a paternally inherited variant of uncertain significance in NOTCH1:c.2153 A > G. We assessed the variant's effect using RT-PCR, finding an increased use of a cryptic donor compared to the control. On this basis, we were able to re-classify this variant as pathogenic.

CONCLUSIONS

We expand the phenotypic spectrum of NOTCH1 and contribute to the building evidence that variants in NOTCH1 cause a spectrum of disorders of vascular development.

Serum C-Reactive Protein as a Potential Indicator for Screening Fecal Calprotectin in Patients With Moderate-to-Severe Hidradenitis Suppurativa: A Cross-Sectional Cohort Study

BACKGROUND

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder frequently associated with immune-mediated comorbidities, including inflammatory bowel disease (IBD). Given the potential risk of IBD, particularly before initiating therapies such as interleukin (IL)-17 inhibitors, screening through a fecal calprotectin (FC) test may be warranted. While FC is a reliable, non-invasive biomarker for ruling out IBD, its cost and limited availability in dermatology settings present challenges. Therefore, this study aims to investigate the potential association between FC and serum C-reactive protein (CRP) levels in patients with moderate-to-severe HS, which may provide a more accessible screening approach.

METHOD

This cross-sectional cohort study was conducted at the Department of Dermatology and Venereology of Uşak University between April 2, 2024, and December 31, 2024, including 18-65-year-old patients with moderate-to-severe HS. Serum CRP and FC levels were analyzed using an enzyme-linked immunosorbent assay (ELISA).

RESULTS

Stool samples from 61 patients with moderate-to-severe HS were included. The median FC and serum CRP levels were 28.2 μg/g and 5.3 mg/L, respectively, with a significant correlation between them (rho = 0.289, p = 0.026). While FC levels did not significantly differ between moderate and severe HS, CRP levels were significantly higher in patients with severe disease (p = 0.009). Receiver operating characteristic (ROC) analysis identified a CRP cut-off of 5.35 mg/L for predicting FC ≥ 50 μg/g (AUC = 0.660, p = 0.045), with 70% sensitivity and 61.5% specificity.

CONCLUSION

Patients with moderate-to-severe HS and serum CRP levels above 5.35 mg/L may benefit from FC screening, and those with FC levels exceeding 50 μg/g may be considered for further endoscopic evaluation to assess IBD.

A current view of the pathogenesis and treatment of primary cutaneous diffuse large B cell lymphoma - leg type

Primary cutaneous diffuse large B cell lymphoma, leg type (PCDLBCL-LT) is an aggressive B cell extranodal variant of lymphoma present in the skin, typically without evidence of extra cutaneous spread at the time of diagnosis. PCDLBCL-LT accounts for 20% of all primary cutaneous B cell lymphomas (CBCL) and 5% of all primary cutaneous lymphomas (PCL). It is more common in the elderly (median age 75 years). The disease commonly manifests as rapidly-growing red to bluish often ulcerating, nodular tumors, plaques or violaceous nodules on one or both lower extremities. Only 10% to 15% of lesions develop in other areas. A prognosis of PCDLBCL-LT is poor, with a 5-year survival rate of 40 to 50%. The first-line treatment of PCDLBCL-LT includes immunochemotherapy, most commonly R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, prednisone). In the case of a solitary lesion, excision or radiotherapy should be considered. Many patients demonstrate cutaneous relapses (70%) or systemic dissemination (50%). Recent studies have reported the use of Bruton's tyrosine-kinase (BTK) inhibitors, BCL2 inhibitors, immunomodulatory drugs and immune check-point inhibitors in treating relapsed or refractory patients. The study summarizes the current view of the pathogenesis, diagnosis and treatment of PCDLBCL-LT, including genetic abnormalities and novel targeted drugs.

A Comprehensive Review of Behcet's Disease Damage Assessment Tools

Outcome assessment of rheumatic diseases has a significant role in evaluating the effect of various therapies in clinical studies and in the treatment of these patients in daily practice. Outcome assessment in rheumatic disorders is based on the evaluation of disease activity, quality of life, disability, and mortality caused by the disease. Behçet's disease (BD) is a multisystem inflammatory condition that can cause damage to multiple organs. Damage assessment, along with assessment of BD activity, are two necessary and complementary components of BD outcome measures, based on Outcome Measures in Rheumatology. In clinical trials of BD, outcome assessment has been based on disease activity measures, which do not measure damage severity. In this review, we considered three damage indices that have recently been introduced to assess BD-related injury, including vasculitis damage index (VDI), Behçet's syndrome overall damage index (BODI), and Behçet's disease damage index (BDI).

Nonsurgical Chin and Prejowl Modification

The chin and prejowl areas play a critical role in the perception of facial harmony. This paper explores nonsurgical approaches for chin and prejowl rejuvenation, emphasizing anatomy, aesthetic concerns, and the plethora of available treatment modalities.Bony landmarks such as the pogonion, menton, and mental protuberance define the chin, while muscles like the mentalis, depressor anguli oris (DAO), and depressor labii inferioris (DLI) influence facial expression and rhytid development. Aging induces volume loss, tissue laxity, and bony absorption, leading to the formation of the prejowl sulcus and reduced jawline definition.Injectable fillers and biostimulators such as hyaluronic acid, calcium hydroxylapatite, and poly-L-lactic acid address volume loss, enhance contours, correct chin underprojection, and fill both deep and superficial rhytids. Neuromodulators like botulinum toxin reduce muscle hyperactivity to smooth dynamic wrinkles. Energy-based modalities, including radiofrequency, ultrasound, and laser, offer options for skin tightening, fat reduction, and improving skin texture.The paper highlights the benefits and limitations of nonsurgical techniques available to treat the chin and prejowl, emphasizing the need for anatomical precision to optimize safety and efficacy. Although nonsurgical treatments cannot replace surgical interventions, they often provide effective, temporary solutions for patients seeking low-downtime alternatives.

LL-37 Inhibits TMPRSS2-Mediated S2' Site Cleavage and SARS-CoV-2 Infection but Not Omicron Variants

Continual evolution of SARS-CoV-2 spike drives the emergence of Omicron variants that show increased spreading and immune evasion. Understanding how the variants orientate themselves towards host immune defence is crucial for controlling future pandemics. Herein, we demonstrate that human cathelicidin LL-37, a crucial component of innate immunity, predominantly binds to the S2 subunit of SARS-CoV-2 spike protein, occupying sites where TMPRSS2 typically binds. This binding impedes TMPRSS2-mediated priming at site S2' and subsequent membrane fusion processes. The mutation N764K within S2 subunit of Omicron variants reduces affinity for LL-37 significantly, thereby diminishing binding capacity and inhibitory effects on membrane fusion. Moreover, the early humoral immune response enhanced by LL-37 is observed in mice against SARS-CoV-2 spike but not Omicron BA.4/5 spike. These findings reveal the mechanism underlying interactions amongst LL-37, TMPRSS2 and SARS-CoV-2 and VOCs, and highlight the distinct mutation for Omicron variants to evade the fusion activity inhibition by host innate immunity.

Variability in phenotype clusters of Behçet's syndrome: A systematic review

BACKGROUND

Behçet's syndrome (BS) is a multisystem vasculitis, and distinct clinical phenotypes with clustering of certain organ manifestations were proposed. However, studies from different cohorts have shown variability in the defined phenotypes. This was attributed to geographic and ethnic differences, but different studies from the same country have also shown variability in phenotype clusters. We aimed to explore the variability in clinical phenotype clustering across different countries and cohorts and possible reasons for these.

METHODS

An electronic search was carried out in PubMed, EMBASE, and Cochrane Library for studies that assessed phenotype clusters in BS cohorts. Two reviewers independently performed the screening of titles, abstracts, and full texts using Covidence.

RESULTS

A total of 15 studies that assessed 17 different cohorts were identified. Several differences were identified in the clusters that were reported in these cohorts. Factors that were identified by this systematic review as possible causes of these differences were study design, statistical analysis method (hierarchical cluster analysis vs. factor analysis), patient population (pediatric vs. adult), setting, diagnostic/classification criteria (International Study Group vs. International Criteria for Behçet's Disease), disease duration, the definition of organ involvement (such as including cerebral sinus thrombosis in nervous system or vascular involvement), ascertainment of manifestations (such as gastrointestinal involvement confirmed by endoscopy or not), and time component for clustering of manifestations.

CONCLUSION

There is important variability in the phenotype clusters that are reported in different studies and this variability seems to stem from methodologic differences between the studies.

Arterial and venous thrombosis in systemic and monogenic vasculitis

Systemic vasculitis, common forms of which include anti-neutrophil cytoplasmic antibody-associated small-vessel vasculitis, large-vessel vasculitis and Behçet syndrome, are frequently complicated by arterial or venous thrombotic events (AVTEs). Newly identified entities such as DADA2 (deficiency of adenosine deaminase 2) and VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome, which are driven by genetic mutations, also exhibit vasculitic features and are associated with a high risk of AVTEs. AVTEs in systemic vasculitis, including monogenic forms of vasculitis, are due to the complex interaction of inflammation and coagulation. New insights into the pathogenetic mechanisms implicate endothelial dysfunction, immune complex deposition and the interplay of pro-inflammatory cytokines with prothrombotic factors, which collectively promote thrombus formation. AVTEs impose a substantial disease burden, complicate diagnosis and negatively affect prognosis by increasing the risk of morbidity and mortality. Early diagnosis and treatment are crucial to prevent lasting damage. Management strategies should target both thrombosis and underlying inflammation. Antithrombotic therapies, including low-dose aspirin, or oral anticoagulants should be used on the basis of individual thrombotic risk assessment. Immunosuppressive therapy is the cornerstone of treatment for arterial and venous thrombosis, particularly in Behçet syndrome, in which vascular inflammation has a crucial role in thrombotic complications.

A Study Comparing 0.025% Topical Tretinoin Versus 4% Retinol Peel and 10% Retinol Peel in the Management of Acanthosis Nigricans

Background

Acanthosis nigricans (AN) presents a significant challenge for dermatologists, as it is a common condition yet often proves resistant to treatment.

Aim and Objective

To compare the effects of 0.025% topical tretinoin, 4% retinol peel, and 10% retinol peel, in the management of AN of neck using Acanthosis Nigricans Area Severity Index (ANASI) score.

Patients and Methods

Patients with AN of neck were recruited to the study with due consideration to the inclusion criteria and were divided into 3 groups based on the treatment administered which was either 0.025% topical tretinoin, 4% retinol peel, or 10% retinol peel. The patients were followed-up every 2 weeks up to 8 weeks with ANASI score and Likert scale.

Results

All the groups demonstrated statistically significant improvement but participants in the topical group achieved a slightly better reduction, with a mean ANASI score of 10 at final follow-up, followed by 10% retinol and 4% retinol peel with a mean ANASI score of 12 and 11, respectively. Overall, though 4% retinol peel group had the least reported side effects, patient satisfaction score was found to be higher among the participants in the topical group.

Limitations

Small sample size and allocation of patients to different treatment groups was not randomized.

Conclusion

Among the three groups, topical tretinoin group showed better response when compared to 4% and 10% retinol peels and, as such, can be a preferred mode of treatment since it is also cost effective over the more expensive chemical peels. Thus, in the era of chemical peels and lasers, topical treatment with retinoids still holds good.

JAK inhibitors as a promising therapy for immune-mediated photodermatoses

Immune-mediated photodermatoses (IMPs) are skin diseases caused by altered immune responses triggered by sunlight, including polymorphous light eruption (PMLE), actinic prurigo (AP), solar urticaria (SU), chronic actinic dermatitis (CAD), and hydroa vacciniforme (HV). Managing IMPs is challenging because of the need for rigorous sun protection and the poor response to conventional therapies, particularly in moderate-to-severe patients. Researchers are exploring new targeted therapies for IMPs, including Janus kinase (JAK) inhibitors, a novel class of small molecules that block the JAK-STAT signaling pathway. Several case reports and series show promising results. This study reviews the evidence-based rationale for using JAK inhibitors in IMP treatment, assessing their efficacy and safety.

European S2k guidelines for hidradenitis suppurativa/acne inversa part 2: Treatment

INTRODUCTION

This second part of the S2k guidelines is an update of the 2015 S1 European guidelines.

OBJECTIVE

These guidelines aim to provide an accepted decision aid for the selection, implementation and assessment of appropriate and sufficient therapy for patients with hidradenitis suppurativa/acne inversa (HS).

METHODS

The chapters have been selected after a Delphi procedure among the experts/authors. Certain passages have been adopted without changes from the previous version. Potential treatment complications are not included, being beyond the scope of these guidelines.

RESULTS

Since the S1 guidelines publication, validation of new therapeutic approaches has almost completely overhauled the knowledge in the field of HS treatment. Inflammatory nodules/abscesses/draining tunnels are the primary lesions, which enable the classification of the disease severity by new validated tools. In relation to the degree of detectable inflammation, HS is classified into the inflammatory and the predominantly non-inflammatory forms. While the intensity of the inflammatory form can be subdivided by the IHS4 classification in mild, moderate and severe HS and is treated by medication accordingly, the decision on surgical treatment of the predominantly non-inflammatory form is based on the Hurley stage of the affected localization. The effectiveness of oral tetracyclines as an alternative to the oral combination of clindamycin/rifampicin should be noted. The duration of systemic antibiotic therapy can be shortened by a 5-day intravenous clindamycin treatment. Adalimumab, secukinumab and bimekizumab subcutaneous administration has been approved by the EMA for the treatment of moderate-to-severe HS. Various surgical procedures are available for the predominantly non-inflammatory form of the disease. The combination of a medical therapy to reduce inflammation with a surgical procedure to remove irreversible tissue damage is currently considered a holistic therapeutic approach.

CONCLUSIONS

Suitable therapeutic options while considering HS severity in the therapeutic algorithm according to standardized criteria are aimed at ensuring a proper therapy.

The underlying mechanism behind the different outcomes of COVID-19 in children and adults

Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has affected hundreds of millions of people globally, resulting in millions of deaths. During this pandemic, children have demonstrated greater resistance than adults, exhibiting lower infection rates, reduced mortality, and milder symptoms. Summarizing the differences in resistance between children and adults during COVID-19 can provide insights into protective mechanisms and potential implications for future treatments. In this review, we focused on summarizing and discussing the mechanisms for better protection of children in COVID-19. These protective mechanisms encompass several factors: the baseline expression of cell surface receptor ACE2 and hydrolase TMPRSS2, the impact of complications on COVID-19, and age-related cytokine profiles. Additionally, differences in local and systemic immune responses between children and adults also contribute significantly, particularly interferon responses, heterologous protection from non-COVID-19 vaccinations, and immune status variations influenced by micronutrient levels. The advantageous protection mechanisms of these children may provide insights into the prevention and treatment of COVID-19. Importantly, while age-related metabolic profiles and differential COVID-19 vaccine responses may contribute to protection in children, current comparative research remains limited and requires further investigation.

Isotretinoin-related post-surgical interface alterations during sun light exposure: A case report

IntroductionRefractive surgery, including procedures like photorefractive keratectomy (PRK) and laser-assisted in situ keratomileusis (LASIK), is increasingly common and generally safe, offering favorable optical outcomes. However, patients' anamnesis often lacks significant clinical information, such as systemic treatments for acne, diabetes, and polycystic ovary syndrome. Isotretinoin, a systemic treatment for severe acne, is rarely associated with corneal abnormalities.Patient and Clinical FindingsThis case report presents a 26-year-old female who underwent PRK for her myopic refractive error in both eyes, without disclosing her systemic isotretinoin therapy.Diagnosis, Intervention, and OutcomesPost-surgery, she developed fine bilateral basal membrane irregularities and subepithelial interface alterations. Despite a change in topical therapy, subepithelial haze persisted but improved over time, achieving an uncorrected distance visual acuity of 20/20 in both eyes at 2.5 months from surgery.ConclusionsIsotretinoin can induce ocular surface changes, including corneal epithelial thickening and stromal thinning, dry eye symptoms, and conjunctival modifications. Concurrent UVB exposure during corneal healing can exacerbate these effects, causing metabolic activation, extracellular matrix production, and corneal thickening. This case report highlights the importance of deepened patient's anamnesis before refractive surgery and suggests further studies on the relative contraindication of perioperative isotretinoin.

Comparative analysis of short-term and long-term LL-37-induced rosacea-like mouse models: Histopathological features and inflammatory immune responses

BACKGROUND

It is well recognized that developing new animal models, refining the existing mouse models, and thoroughly characterizing their features are essential for gaining a deeper understanding of rosacea pathogenesis and for advancing therapeutic strategies in this direction. Accordingly, we aimed to characterize the pathological features of a long-term LL-37-induced mouse model of rosacea and to compare the disease manifestations and pathophysiological characteristics between short-term and long-term LL-37-induced models. A key focus was to investigate differential gene expression and the underlying mechanisms of immune system dysregulation in these models.

METHODS

We comparatively assessed skin lesion manifestations, the extent of inflammatory infiltration, sebaceous gland alterations, fibrosis, and angiogenesis in both models. Assessments were performed using photographic documentation, hematoxylin-eosin (HE) staining, Van Gieson's (VG) staining, immunohistochemistry, and Western blotting. Furthermore, we employed RNA sequencing to analyze differential gene expression in mouse skin. The RNA sequencing data were validated using immunofluorescence staining and Western blotting, with a specific focus on gene variations and mechanisms related to immune system dysregulation.

RESULTS

Mice subjected to long-term LL-37 induction developed rosacea-like pathological features, including angiogenesis, thickened skin tissue, and sebaceous gland hypertrophy. In the short-term LL-37-induced model, immune dysregulation primarily involved the innate immune response. However, long-term LL-37 induction resulted in significant activation of both innate and adaptive immune responses.

CONCLUSION

The long-term LL-37-induced mouse model offers a valuable animal model for the detailed investigation of the pathological mechanisms driving moderate-to-severe rosacea with prolonged disease duration. Importantly, this model provides a significant experimental foundation for exploring the potential role of immune system dysregulation in rosacea pathogenesis.

Case Report: ABO-incompatible living donor liver transplantation in a patient with associated Rosai-Dorfman-Destombes disease, first reported case

Rosai-Dorfman-Destombes disease (RDD), a rare histiocytic proliferation, is often associated with lymphadenopathy and extranodal manifestations, including involvement of the liver. We report a unique case of RDD presenting with chronic liver disease (CLD) in a 7-year-old boy, highlighting the association between these conditions. The patient underwent ABO-incompatible living donor liver transplantation (LDLT), a procedure not previously documented in the context of RDD. Successful transplantation was preceded by a desensitization protocol including rituximab and immunoadsorption, and was followed by a satisfactory postoperative course. This case underscores the need for further investigation into the relationship between RDD and CLD and the potential of LDLT as a life-saving treatment option in such complex cases.

Extended Analysis of the Hospitalization Cost and Economic Burden of COVID-19 in Romania

Background/Objectives: COVID-19 has impacted Romania's healthcare, economy, society, and public health. This study aims to evaluate the financial impact of the COVID-19 pandemic in Romania by analyzing both hospital costs and key elements of economic costs. The assessment was conducted from the perspective of the national payer. Hospital costs were analyzed covering two distinct timeframes: Q4 2020-Q3 2021 and Q1 2022-Q4 2022. The estimation of economic costs covered Q4 2020-Q3 2021. Methods: Hospital care costs were estimated using financial data from eight hospitals. The costs were extrapolated to inpatient data from 60 public hospitals for each of the two study periods. The disease burden was determined based on official data, including the number of confirmed cases, hospital bed occupancy, reported fatalities, and various cost components from an economic perspective. Results: The findings indicate that the average hospital cost per patient episode was EUR 2267 (95% CI: 2137-2396) during the first period and EUR 2003 (95% CI: 1799-2207) in the second. The total national hospitalization expenses amounted to EUR 1.35 billion and EUR 730 million, respectively. When accounting for productivity losses and testing costs, the overall expenditure reached EUR 5.39 billion for Q4 2020-Q3 2021. Conclusions: In conclusion, the total economic burden of the COVID-19 pandemic in Romania by the end of 2021 was estimated at EUR 5.39 billion, encompassing hospitalization, isolation, premature deaths, quarantine, testing, and parental allowances. Despite the emergence of costlier treatment options, overall treatment costs declined, possibly due to increased vaccination rates. The study highlights the significant financial strain on the healthcare system and underscores the importance of evidence-based resource allocation to better manage future public health crises.

Evaluation of 1565-nm nonabrasive fractional laser efficacy on atrophic facial acne scars in Chinese population using 22-MHz digital ultrasonography

OBJECTIVE

The purpose of this study was to evaluate the effectiveness of 1565 nm NAFL treatment for atrophic acne scars using 22-MHz digital ultrasonography.

METHODS

A total of 29 patients with acne atrophic scars were sequentially enrolled in this study. Digital clinical images of each patient's face were collected. The Quantitative Global Acne Scarring Grading System developed was employed to assess the outcomes of acne atrophic scars treated by 1565 nm NAFL. Two independent dermatologists performed an ultrasound examination of the acne atrophic scars using 22-MHz ultrasonography.

RESULTS

Of all the patients received 1565 nm NAFL treatment, no adverse side effect was detected. The mean scores of Assessments Quantitative Global Acne Scarring Grading System in all the patients were no significant difference between the baseline and after 1-, 2-, and 3-month treatment. The means of epidermal thickness, dermal thickness, and epidermal echo intensity at the baseline and 1-, 2-, and 3-months were of no significant difference (P>0.05). The differences in the means of dermal echo intensity between the baseline and 1-, 2-, and 3- months were statistically significant (P<0.05).

CONCLUSION

1565 nm NAFL was effective in improving the acne atrophic scars due to increased collagen fiber synthesis detected by 22 MHz frequency ultrasound system.

[Translated article] Low-dose Oral Minoxidil for Frontal Fibrosing Alopecia: A 122-patient Case Series

The objective of our study was to analyze the effectiveness of oral minoxidil on the frontotemporal hairline in patients with FFA. We conducted a retrospective, descriptive, multicenter study in 2 Brazilian and 1 Spanish centers. Responses were graded on a scale of 3 positive points. A total of 122 patients were included. Subjective improvement in the density of the frontotemporal hairline was observed in 45.1% patients, which was categorized as mild (34.4%), moderate (9.0%), and excellent (1.6%). Hair density improved in 57.4% of the patients' interparietal. Additionally, 25.4% and 3.3% of the patients experienced eyebrow and eyelash growth, respectively. Adverse effects were detected in 33.6% patients, with hypertrichosis being the most common (23.8%). In this study, oral minoxidil proved to be an additional therapy for FFA that not only improved the patients' overall hair and eyebrow growth, but also the density of the frontotemporal hairline.

De novo manifestations during adalimumab treatment in Behçet's syndrome

OBJECTIVES

Treatment response may be variable across organ manifestations of Behçet's syndrome (BS). We aimed to determine the frequency of de novo manifestations during adalimumab treatment.

METHODS

We conducted a chart review of all BS patients who received adalimumab in our centre between 2008 and 2023. Demographic data, reasons for initiating adalimumab, concurrent medications, previous treatments, and outcomes were recorded. We defined de novo manifestations as new BS manifestations that occurred for the first time during treatment with adalimumab. For patients with vascular involvement, a new vascular event at another vessel was also considered as a de novo manifestation.

RESULTS

Among the 335 patients, a de novo manifestation developed in 14 (4%) patients. De novo manifestations were vascular involvement in five patients, arthritis in three, anterior uveitis in two, nervous system involvement in two, gastrointestinal involvement in one, and epididymitis in one patient. The primary reasons for adalimumab treatment were vascular involvement in five patients, uveitis in four, arthritis in three, mucocutaneous involvement in one, and epididymitis in one patient. Upon the development of de novo manifestation, adalimumab was switched to another biologic in four patients, dose was intensified in three, colchicine, conventional immunosuppressives and/or glucocorticoids were added in five, and topical eye drops were added in two patients, leading to remission of de novo manifestations in all patients.

CONCLUSION

De novo manifestations were infrequent (4%) among BS patients treated with adalimumab. Of these, 57% were major organ involvement, mainly vascular involvement. None of the patients developed posterior uveitis.

Rosai-Dorfman Disease in a 4-Month-Old Female Presenting With Cervical Lymphadenopathy

Rosai-Dorfman disease is a rare histiocytic disorder that can mimic malignancies. This case highlights the importance of immunohistochemistry in distinguishing RDD from lymphoproliferative neoplasms, ensuring accurate diagnosis and management. Clinicians should consider RDD in unexplained soft tissue masses to avoid misdiagnosis and unnecessary interventions.

A Rare Case of Delayed-Onset Hypersensitivity Reaction and Complete Secondary Treatment Failure Following Repeated Cosmetic Botulinum Toxin Type A Injections

BACKGROUND

Cosmetic botulinum toxin type A (BTX-A) injections have been widely used for improving facial aesthetics. Although the procedure is generally safe, immune-mediated adverse events, such as hypersensitivity reactions and secondary treatment failures, may rarely occur. We report the first case in which repeated BTX-A injections resulted in both a delayed-onset cutaneous hypersensitivity reaction and complete secondary treatment failure.

CASE REPORT/METHODS

A 42-year-old female, with a history of successful BTX-A treatments for glabellar lines and masseter hypertrophy, experienced diminished efficacy following a treatment session. Ten hours after a touch-up injection, she developed facial swelling and edematous erythema localized to the injection sites. These manifestations persisted for over one month without any observable aesthetic improvement, indicating complete secondary treatment failure. The therapeutic effect was not restored even after switching to an alternative BTX-A formulation. We hypothesize that the patient's local hypersensitivity reaction represents a type III immune complex-mediated response (Arthus reaction) driven by IgG antibodies. The repeated BTX-A injections may have induced neutralizing IgG antibodies that, in concert with the cutaneous hypersensitivity reaction, contributed synergistically to both the cutaneous reaction and the complete treatment failure. The short interval between the injections may have facilitated these immunologic events.

CONCLUSION

This case underscores the importance for clinicians to remain vigilant regarding the potential for delayed-onset cutaneous allergic reactions and complete secondary treatment failure following repeated BTX-A injections.

Plasmapheresis for Facilitating Readministration of Rituximab After Paradoxical Exacerbation in Pemphigus Vulgaris: A Case Report

Rare reports of post-rituximab exacerbation of pemphigus vulgaris (PV) have been published, with some therapeutic protocols proposed for managing this condition. A 40-year-old female with PV experienced an exacerbation of mucocutaneous lesions following rituximab administration. She failed to respond to conventional immunosuppressive agents, intravenous immunoglobulin, and ocrelizumab, so plasmapheresis was administered. Then, further doses of rituximab were prescribed, and mucocutaneous lesions improved significantly. We propose plasmapheresis as a possible treatment for post-rituximab PV exacerbation, also noting that subsequent doses of rituximab can be safe and effective.

Hailey-Hailey Disease: A Case Report

Hailey-Hailey disease should be considered in patients with recurrent, painful, pruritic, vesicular lesions in flexural areas. Early diagnosis through histopathology and immunofluorescence allows effective management with corticosteroids, emollients, and lifestyle modifications, leading to significant improvement and symptom resolution.

Low-dose oral minoxidil for frontal fibrosing alopecia: a 122-patient case series

The objective of our study was to analyze the effectiveness of oral minoxidil on the frontotemporal hairline in patients with FFA. We conducted a retrospective, descriptive, multicenter study in 2 Brazilian and 1 Spanish centers. Responses were graded on a scale of 3 positive points. A total of 122 patients were included. Subjective improvement in the density of the frontotemporal hairline was observed in 45.1% patients, which was categorized as mild (34.4%), moderate (9.0%), and excellent (1.6%). Hair density improved in 57.4% of the patients' interparietal. Additionally, 25.4% and 3.3% of the patients experienced eyebrow and eyelash growth, respectively. Adverse effects were detected in 33.6% patients, with hypertrichosis being the most common (23.8%). In this study, oral minoxidil proved to be an additional therapy for FFA that not only improved the patients' overall hair and eyebrow growth, but also the density of the frontotemporal hairline.

Comparison of topical potassium hydroxide 5% solution with cryotherapy in the treatment of patients with genital warts: A randomized controlled clinical trial

BACKGROUND

Given the therapeutic challenge of wart treatment and the need for an ideal treatment that is effective, noninvasive, cost-effective, and has minimal side effects, this study aims to compare the local impact of a 5% potassium hydroxide (KOH) solution with cryotherapy, the current standard treatment for genital warts.

METHODS

Two groups, each consisting of 49 patients: the first group was treated with a daily topical application of 5% KOH solution using a swab, while the second group underwent cryotherapy in two 5-20 s freeze-thaw cycles. Before treatment, patient demographic data and number of lesions were recorded. Follow-up visits were conducted at four-week intervals for 12 weeks, during which the number of lesions, time to complete recovery, and skin-related side effects were examined and recorded, ensuring comprehensive data collection.

RESULTS

A total of 98 patients (average age: 28.40 ± 7.34 years), 55 cases (55.1%) being female and 43 cases (43.9%) being male. Importantly, there was no significant difference in terms of gender (p = .684), education (p = .533), and marital status (p = .703) between the two study groups. Further, no significant difference in previous infection history (p = .493) and partner infection (p = .098) was identified. There was no significant difference in terms of treatment response (p = .510) and relapse (p < .999) between the two KOH and cryotherapy study groups.

CONCLUSION

The study found no significant differences in treatment response, relapse rates, or side effects between using 5% potassium hydroxide solution and cryotherapy for genital wart treatment. These findings suggest that both modalities offer comparable efficacy and safety profiles, providing clinicians with valuable options in tailoring treatment approaches for patients with genital warts.

Accuracy of ChatGPT 3.5, 4.0, 4o and Gemini in diagnosing oral potentially malignant lesions based on clinical case reports and image recognition

BACKGROUND

The accurate and timely diagnosis of oral potentially malignant lesions (OPMLs) is crucial for effective management and prevention of oral cancer. Recent advancements in artificial intelligence technologies indicates its potential to assist in clinical decision-making. Hence, this study was carried out with the aim to evaluate and compare the diagnostic accuracy of ChatGPT 3.5, 4.0, 4o and Gemini in identifying OPMLs.

MATERIAL AND METHODS

The analysis was carried out using 42 case reports from PubMed, Scopus and Google Scholar and images from two datasets, corresponding to different OPMLs. The reports were inputted separately for text description-based diagnosis in GPT 3.5, 4.0, 4o and Gemini, and for image recognition-based diagnosis in GPT 4o and Gemini. Two subject-matter experts independently reviewed the reports and offered their evaluations.

RESULTS

For text-based diagnosis, among LLMs, GPT 4o got the maximum number of correct responses (27/42), followed by GPT 4.0 (20/42), GPT 3.5 (18/42) and Gemini (15/42). In identifying OPMLs based on image, GPT 4o demonstrated better performance than Gemini. There was fair to moderate agreement found between Large Language Models (LLMs) and subject experts. None of the LLMs matched the accuracy of the subject experts in identifying the correct number of lesions.

CONCLUSIONS

The results point towards cautious optimism with respect to commonly used LLMs in diagnosing OPMLs. While their potential in diagnostic applications is undeniable, their integration should be approached judiciously.

Investigation of corneal topographic and ocular surface parameters in ocular rosacea based on skin subtypes

OBJECTIVE

To compare the corneal topographic parameters and ocular surface parameters of ocular rosacea (OR) patients across skin subtypes of the disease and healthy controls.

METHODS

This prospective study included 180 eyes of 90 OR patients and 60 eyes of 30 healthy controls. Among the OR patients, 30 had phymatous (60 eyes), 30 had erythematotelangiectatic (60 eyes) and 30 had papulopustular skin types (60 eyes). We measured the mean keratometry (Kmean), maximum keratometry (Kmax), thinnest corneal thickness (TCT), central corneal thickness (CCT) and corneal volume (CV) with a topography device (Sirius, Italy). Additionally, we measured tear-film breakup time (TBUT), Meiboscore and Schirmer's test from all participants. We compared parameters across OR skin groups as well as with controls.

RESULTS

Kmean and Kmax were significantly steeper in the OR group compared to controls (p<0.05). We found significant correlations between "Kmean-Kmax", "CV-TCT", "CV-CCT", and "TCT-CCT" in both groups, while significant correlations between "age-Kmean", "age-Kmax", and "Meiboscore-Kmax" were present only in OR patients. When patients were divided into subgroups according to their skin subtypes, the papulopustular and phymatous subgroups had steeper Kmean and Kmax compared to the erythematotelangiectatic and control groups (P<0.05). The papulopustular subgroup had lower CCT, lower TBUT and higher Meiboscore compared to the phymatous, erythematotelangiectatic and control groups but lower TCT compared to controls (P<0.05). In addition, there were significant correlations between "Kmax-CV", "Kmax-TCT", and "Kmax-meiboscore" only in the papulopustular subgroup (P<0.05).

CONCLUSION

It appears that the corneas of OR patients are steeper than those of healthy controls; corneal thinning and abnormalities of ocular surface parameters are more pronounced in papulopustular skin types.

Pumping the Breaks on Acantholytic Skin Disorders: Targeting Calcium Pumps, Desmosomes, and Downstream Signaling in Darier, Hailey-Hailey, and Grover Disease

Acantholytic skin disorders, by definition, compromise intercellular adhesion between epidermal keratinocytes. The root cause of blistering in these diseases traces back to direct disruption of adhesive cell-cell junctions, exemplified by autoantibody-mediated attack on desmosomes in pemphigus. However, genetic acantholytic disorders originate from more indirect mechanisms. Darier disease and Hailey-Hailey disease arise from mutations in the endoplasmic reticulum calcium pump, SERCA2, and the Golgi calcium/manganese pump, SPCA1, respectively. Though the disease-causing mutations have been known for nearly 25 years, the mechanistic linkage between dysregulation of intracellular ion stores and weakening of cell-cell junctions at the plasma membrane remains puzzling. The molecular underpinnings of a related idiopathic disorder, Grover disease, are even less understood. Due to an incomplete understanding of acantholytic pathology at the molecular level, these disorders lack proven, targeted treatment options, leaving patients with the significant physical and psychological burdens of chronic skin blistering, infections, and pain. This article aims to review what is known at the molecular, cellular, and clinical levels regarding these under-studied disorders and to highlight knowledge gaps and promising ongoing research. Armed with this knowledge, our goal is to aid investigators in defining essential questions about disease pathogenesis and to accelerate progress toward novel therapeutic strategies.

Dupilumab, a Potential Novel Treatment for Hailey-Hailey Disease

Background/Objectives: Hailey-Hailey disease (HHD) is an uncommon genodermatosis with autosomal dominant inheritance caused by loss-of-function mutations in the ATP2C1 gene, which lead to disruption in keratinocyte adhesion and intraepidermal acantholysis. The chronic nature of the disease, its frequent recurrences and the lack of specific treatment pose real challenges in the long-term management of these patients. Recent studies have evaluated the effect of dupilumab, a human monoclonal antibody that blocks interleukin-4 and -13 receptor in refractory HHD, with very promising results. The aim of this study was to review the published data on the use of dupilumab for the treatment of HHD, to present our own experience in the field, and to discuss the mechanisms underlying dupilumab's beneficial effects in HHD and the future treatment perspectives. Methods: A search of the medical literature on the use of dupilumab in the treatment of HHD was conducted. The terms "Hailey-Hailey disease", "benign familial pemphigus", "benign chronic pemphigus", and "dupilumab" were searched across multiple databases (Medline, Chrocane Library, EMBASE) from inception until 30 September 2024. Results: To date, six manuscripts describing 11 refractory HHD cases treated with dupilumab have been published. All the patients experienced significant clinical improvement. The authors reported sustained disease quiescence in seven patients (64%), monitored for 5 to 24 months. None of the patients experienced adverse effects related to dupilumab. To the existing evidence, we add a new case of recalcitrant HHD successfully treated with dupilumab. Conclusions: Mounting evidence indicates dupilumab as a safe and efficient therapeutic alternative in patients with severe, refractory HHD. However, the long-term efficacy of dupilumab and the optimal therapeutic regimen for HHD are yet to be determined.

Very long-term remission in behcet's disease following withdrawal of anti-TNF treatment exceeds relapses: a reappraisal of an outcome study

BACKGROUND

Introduction of anti-TNF treatment has greatly improved prognosis of Behcet's disease (BD). Withdrawal of anti-TNF treatment in chronic inflammatory arthritis or bowel disease has been associated with sustained remission in subsets of patients. Herein, we examined the probability of very long-term quiescence after withdrawal of TNF inhibitors in BD.

METHODS

Retrospective longitudinal outcome single-center study focusing on BD patients who discontinued successful ant-TNF treatment since 2001. Endpoint was their proportion with sustained clinical remission for 5 years after withdrawal.

RESULTS

Thirty-three patients with severe BD refractory to non-biologic treatment (mean age 47.5 ± 11.5 years, 55% men) achieved TNF inhibitor-induced remission for a median of 2 years (IQR [1-2.6]). TNF inhibitors had been given for sight-threatening disease (28/33, 82%), for mucocutaneous (3/33), central nervous system (2/33) and gastrointestinal involvement (1/33). After withdrawal, BD remained in remission in 15/33 patients for 6.6 to 20.6 years (mean 13.5 ± 3.8). Conversely, 18/33 patients relapsed after a median of 9.5 months [IQR 8-12, range 4-32] following withdrawal but retreatment with TNF inhibitors was effective in 13/18. Of them, 9/13 discontinued for a second time and achieved again the study's endpoint, remaining in remission for median of 7.4 years ([IQR 5-9.3, range 5-15 years). Study's end-point was met by 24/33 patients (73%); 17and 7 patients remain any-drug free or on azathioprine only, respectively.

CONCLUSION

Discontinuation of successful anti-TNF treatment is frequently associated with durable very long-term remission in severe BD. Additional studies are needed since relapses not responding to anti-TNF re-treatment may occur.

Human Papilloma Virus Infection in Men: A Specific Human Virome or a Specific Pathology?

BACKGROUND

Human papillomavirus (HPV) infections in men remain under-researched despite their critical role in disease transmission and the increasing incidence of HPV-related cancers. This study investigates the clinical and molecular characteristics of anogenital HPV infections in men, emphasizing genotype prevalence, diagnostic methods, and lesion variability.

METHODS

A cross-sectional study was conducted on 70 men aged 18-65 years with clinically diagnosed anogenital HPV infection. Lesions were characterized by morphology and location. HPV DNA was analyzed using INNO-LiPA (INNOvative Line Probe Assay), Hybrid Capture II (HC II), and polymerase chain reaction (PCR) assays to determine genotype distribution. Associations between clinical features and HPV genotypes were assessed using multivariate statistical analyses.

RESULTS

Lesions varied in morphology, with verrucous (52.86%) and papular (30%) types being the most common. Localization patterns showed predominance on the penis radix (34.29%) and shaft (27.14%). Molecular testing revealed HPV DNA in 88.57% of the cases using INNO-LiPA, compared to 45% and 40% with HC II and PCR, respectively. Low-risk (LR) genotypes, particularly HPV6, dominated single infections, comprising 68.57% of the cases, while high-risk (HR) genotypes accounted for 20%. Mixed LR and HR infections were observed in 14.29% of the lesions, with greater diversity noted in distal genital regions. Notably, condyloma plana and lesions on the inner prepuce exhibited a higher prevalence of HR and mixed infections. Age and lesion duration showed trends toward older patients and longer disease duration in cases involving perianal and extragenital condylomas, though these findings were not statistically significant. No direct correlation between lesion type or localization and specific genotypes was identified, underscoring the heterogeneity of HPV clinical manifestations in men.

CONCLUSIONS

Anogenital HPV infections in men exhibit significant heterogeneity in lesion morphology, localization, and genotype distribution. HR HPV genotypes were detected in a notable proportion of benign lesions, underscoring their potential role in disease progression. INNO-LiPA proved superior in diagnostic accuracy, highlighting the need for standardized and cost-effective diagnostic approaches for men. Further research is crucial to elucidate HPV's clinical impact in men and inform prevention and treatment strategies.

Oral anticancer promising of hexadecanoic acid through melecular interaction to nuclear factor-kappa-B p65/RELA and tumor suppressor-p53

Ambonese banana stem extract (Musa paradisiaca var. sapientum (L.) Kuntze) has been proven to contain the active compound Hexadecanoic acid (Hexa) which can suppress the growth of cancer cells through the apoptosis process. The aims to determine HA interaction to nuclear factor-kappa-B p65/RELA and tumor suppressor-p53 for the development of oral anticancer drugs through molecular docking. In silico molecular docking study carried out include prediction of activity spectra of substances (PASS), drug-likeness analysis based on the lipinski rule of five principles, absorption, distribution, metabolism, excretion, and toxicity (ADMET) study, molecular docking and Hexa bond visualization (CID: 985), along with the positive control comparison 5-fluorouracil (Fluo) (CID: 3385) and the derivative compound 9-octadecenoic acid (Octa) (CID: 445639) which bind to the proteins target RELA (PDB ID: 6NV2) and p53 (PDB ID: 2OCJ). The Hexa, Fluo and Octa compounds' tests were negative for AMES toxicity, indicating that these compounds do not cause genetic mutations. The acute oral toxicity tests yielded values of 1.44 mol/kg for Hexa, 1.939 mol/kg for Fluo and 1.417 mol/kg for Octa. Molecular docking results and bond visualization indicate that the affinity of 9-octadecenoic acid interacts better with RELA and p53 compared to the positive control, i.e. 5-fluorouracil. Hexa compound exhibits a superior binding pocket compared to Fluo and Octa, particularly against the p53 target protein. Hexadecanoic acid compound in Musa paradisiaca var. sapientum (L.) Kuntze represents a breakthrough in developing a new anticancer potential and effectiveness against RELA and p53.

The relationship of disease severity with C-reactive protein/albumin ratio and hematological parameters in patients with rosacea

This study aims to investigate the effectiveness of the C-reactive protein/albumin ratio (CAR) and parameters derived from complete blood counts as indicators of inflammatory activity in patients with rosacea and to evaluate their association with disease severity. This retrospective cross-sectional study included 90 rosacea patients classified into three groups based on the Investigator Global Assessment (IGA) score: 30 with mild, 30 with moderate, and 30 with severe disease, along with 30 healthy controls. There were no significant differences between the patient and control groups in terms of gender (%31.1 vs. %30 male) and age (41.92 ± 10.70 years vs. 41.07 ± 11.92 years). In rosacea patients, neutrophil (P = 0.0004), lymphocyte (P = 0.031), platelet (P = 0.041), monocyte (P = 0.003), CRP (P < 0.0001), and CAR (P < 0.0001) levels were significantly higher. The AUC value for CAR was 0.83, with a cut-off value of 0.91; sensitivity was 66.67%, and specificity was 96.67%. Significant differences were observed among the three patient groups classified by rosacea severity for neutrophil (P < 0.0001), lymphocyte (P = 0.011), monocyte (P = 0.0001), CRP (P < 0.0001), albumin (P < 0.0001), CAR (P < 0.0001), neutrophil/lymphocyte ratio (NLR) (P = 0.004), and lymphocyte/monocyte ratio (LMR) (P = 0.021). Patients with rhinophyma had higher neutrophil (P = 0.005) and NLR (P = 0.019) levels. Those with ocular involvement had higher CRP (P = 0.003) and CAR (P = 0.002) levels, while albumin (P = 0.024) levels were lower. This study is the first to examine the relationship between CAR, rosacea severity, and different clinical types. Based on our findings, we believe that CAR and other hematological parameters can be used to assess the severity of rosacea and monitor various clinical types.

A Fentanyl Hapten-Displaying Lipid Nanoparticle Vaccine that Non-Covalently Encapsulates a TLR7/8 Agonist and T-Helper Epitope Induces Protective Anti-Fentanyl Immunity

Opioid use disorder - particularly involving fentanyl - has precipitated a public health crisis characterized by a significant increase in addiction and overdose-related deaths. Fentanyl-specific immunotherapy, which aims at inducing fentanyl-specific antibodies capable of binding fentanyl molecules in the bloodstream, preventing their entry in the central nervous system, is therefore gaining momentum. Conventional opioid designs rely on the covalent conjugation of fentanyl analogues to immunogenic carrier proteins that hold the inherent capacity of mounting immunodominant responses. Here, we present an alternative fentanyl vaccine design that utilizes a non-covalent assembly of lipid nanoparticles (LNPs) to deliver fentanyl haptens in conjunction with a CD4+ T-helper peptide epitope and an imidazoquinoline TLR7/8 agonist. Our results demonstrate that a single intramuscular administration of the LNP-based nanovaccine elicits fentanyl-specific antibodies, significantly mitigating the effects of opioid overdose in preclinical mouse models. Furthermore, we analyzed the immunobiological behavior of the vaccine in vivo in mouse models, providing evidence that covalent attachment of a fentanyl hapten to a carrier proteins or peptide epitope is not necessary for inducing an effective immune response. However, co-delivery - specifically, the physical assembly of all immune cues into an LNP - remains essential for inducing hapten-specific immunity.

Vitamin D Deficiency Meets Hill's Criteria for Causation in SARS-CoV-2 Susceptibility, Complications, and Mortality: A Systematic Review

Clinical trials consistently demonstrate an inverse correlation between serum 25-hydroxyvitamin D [25(OH)D; calcifediol] levels and the risk of symptomatic SARS-CoV-2 disease, complications, and mortality. This systematic review (SR), guided by Bradford Hill's causality criteria, analyzed 294 peer-reviewed manuscripts published between December 2019 and November 2024, focusing on plausibility, consistency, and biological gradient. Evidence confirms that cholecalciferol (D3) and calcifediol significantly reduce symptomatic disease, complications, hospitalizations, and mortality, with optimal effects above 50 ng/mL. While vitamin D requires 3-4 days to act, calcifediol shows effects within 24 h. Among 329 trials, only 11 (3%) showed no benefit due to flawed designs. At USD 2/patient, D3 supplementation is far cheaper than hospitalization costs and more effective than standard interventions. This SR establishes a strong inverse relationship between 25(OH)D levels and SARS-CoV-2 vulnerability, meeting Hill's criteria. Vitamin D3 and calcifediol reduce infections, complications, hospitalizations, and deaths by ~50%, outperforming all patented, FDA-approved COVID-19 therapies. With over 300 trials confirming these findings, waiting for further studies is unnecessary before incorporating them into clinical protocols. Health agencies and scientific societies must recognize the significance of these results and incorporate D3 and calcifediol for prophylaxis and early treatment protocols of SARS-CoV-2 and similar viral infections. Promoting safe sun exposure and adequate vitamin D3 supplementation within communities to maintain 25(OH)D levels above 40 ng/mL (therapeutic range: 40-80 ng/mL) strengthens immune systems, reduces hospitalizations and deaths, and significantly lowers healthcare costs. When serum 25(OH)D levels exceed 70 ng/mL, taking vitamin K2 (100 µg/day or 800 µg/week) alongside vitamin D helps direct any excess calcium to bones. The recommended vitamin D dosage (approximately 70 IU/kg of body weight for a non-obese adult) to maintain 25(OH)D levels between 50-100 ng/mL is safe and cost-effective for disease prevention, ensuring optimal health outcomes.

The Response of Patients' Immune System After Facial Mesotherapy

BACKGROUND

Facial mesotherapy is a minimally invasive cosmetic procedure involving the injection of active substances into the dermis and subcutaneous tissue. Although generally considered safe, complications such as granulomatous inflammation can arise due to improper techniques or unregulated products. This case report highlights the immune response to facial mesotherapy and its clinical management.

MATERIALS AND METHODS

A 50-year-old woman presented with erythematous, hard, and painless facial nodules three weeks after undergoing mesotherapy in a non-medical setting. A detailed clinical examination, laboratory tests, histopathological analysis, and immunohistochemical evaluation were performed. Tissue expression of CD3, CD20, and CD68 markers was quantified using morphometric analysis. Statistical analysis was conducted to compare the expression of immune markers.

RESULTS

Histopathological examination revealed granulomatous inflammation dominated by macrophages. Immunohistochemical analysis showed significantly higher macrophage activity (CD68, mean reaction area: 5,982.76 µm2) compared to T lymphocytes (CD3, 1,775.12 µm2) and B lymphocytes (CD20, 187.55 µm2) (p < 0.001). Initial treatment included antibiotics, corticosteroids, and topical therapies. Subsequent interventions involved intralesional triamcinolone, oral glucocorticoids, and platelet-rich plasma therapy. Significant clinical improvement was observed within three months, with satisfactory cosmetic outcomes achieved after one year.

CONCLUSION

Granulomatous inflammation is a potential complication of facial mesotherapy, particularly when performed in non-medical settings. Effective management requires timely diagnosis, a combination of systemic and topical treatments, and long-term follow-up. This case underscores the need for standardized mesotherapy protocols and medical oversight to minimize risks.

Rhinophyma treatment: An observational study comparing the results of the cold blade technique and ablative fractional CO2-laser

Experts have widely discussed rhinophyma treatment, proposing and testing various therapies over the years. The aim of this retrospective study was to compare the aesthetic outcomes of patients undergoing the cold blade technique at the Department of Plastic Surgery and ablative fractional carbon dioxide (CO2) laser treatment at the Department of Dermatology at Zealand University Hospital. We assessed rhinophyma severity using the RHISI scale with pre-and post-operative photographs evaluated by senior consultants from each department, who were blinded to the treatment method. Additionally, the patients completed a questionnaire to gauge their satisfaction and willingness to recommend the procedure. Cosmetic outcomes were deemed excellent or good (75% for surgery and 71% for CO2-laser) in both treatment methods. Only one patient answered with moderate satisfaction. Therefore, we recommend both methods as possible treatment options.

Development of Posterior Uveitis in Behçet Syndrome Patients with Vitreous Cells at Baseline

PURPOSE

The prognostic importance of vitreous cells (VC) in patients with Behçet syndrome (BS) is unknown. We aimed to determine the frequency of developing posterior uveitis (PU) and any additional risk factors associated with the development of PU in BS patients with VC at diagnosis.

METHODS

The charts of 572 consecutive BS patients who were registered between 2010 and 2012 were reviewed. Among the patients with a follow-up of ≥2 years, we included 110 patients with VC in one or both eyes and 147 patients without any eye findings in both eyes at baseline and compared them for the development of PU.

RESULTS

Among the 110 included patients with VC, 61 had VC in both eyes, 34 had VC in only one eye, and 15 had VC in one eye and PU in the other eye. There was anterior uveitis (AU) in addition to VC in the same eye in 13 patients at baseline. PU developed in 24 (22%) of these patients during a mean follow-up of 1.9 ± 1.1 years. This was significantly more frequent than the 147 patients without any eye findings at baseline, among whom there were only 2 patients who developed PU (p < 0.001). Multivariate logistic regression analysis showed that having AU in addition to VC in the same eye (OR, 5.03, 95% CI; 1.37-18.47) was an independent risk factor for the development of PU in patients with VC.

CONCLUSION

Careful follow-up is required for patients with VC at diagnosis, since 22% developed PU within 2 years.

Neuro-Behçet leading to coma: A case report

Neuro-Behçet disease is often difficult to diagnose due to its complex and severe clinical presentation. This article reports the case of a 35-year-old female patient with a history of Behçet's disease, admitted for a deep coma. Brain MRI performed upon admission revealed extended lesions in the basal ganglia, thalami, and midbrain, along with leptomeningeal contrast enhancement in the temporal region, suggesting meningoencephalitis compatible with parenchymal involvement of neuro-Behçet's disease. Following a comprehensive negative evaluation for infectious and malignant causes, combined with the patient's medical history, a diagnosis of neuro-Behçet disease was established.

Behçet syndrome with eye involvement

Behçet's uveitis (BU) is a significant form of major organ involvement in Behçet syndrome and is associated with considerable morbidity. Ocular examination is crucial for diagnosing BS and detecting vitreous cells, even in asymptomatic patients. The primary goals in managing BU are to rapidly suppress ocular inflammation and prevent relapses. Initial treatment for posterior segment involvement in BU typically involves immunosuppressive agents combined with glucocorticoids. Biologic agents are increasingly used in BU management, including as first-line treatments for patients with poor prognostic risk factors or sight-threatening uveitis. There is no established consensus on when to discontinue or taper immunosuppressive therapy. Once remission is achieved, the absence of retinal vasculitis should be confirmed with fluorescein angiography, which should be utilized throughout the process of tapering immunosuppressive therapy. In addition to monoclonal tumor necrosis factor-alpha antagonists and tocilizumab, Janus kinase inhibitors may offer the potential for managing BU in the future.

Impact of Vitamin D Levels on Clinical Outcomes in SARS-CoV-2 Infections

BACKGROUND AND AIM

Since its emergence in 2019, SARS-CoV-2 has caused the global COVID-19 pandemic, presenting significant challenges for healthcare systems worldwide. Extensive research has focused on diagnostics, treatments, and vaccine development to combat the virus. Given the need for effective strategies to reduce infection rates, disease progression, and severity, this study aimed to investigate the potential role of vitamin D (25OHD) in mitigating the severity of COVID-19.

METHODS

A cross-sectional study was conducted to evaluate the relationship between serum vitamin D levels and the severity of COVID-19 symptoms. Vitamin D levels were measured using the Roche Diagnostics Vitamin D assay in 100 SARS-CoV-2-infected patients confirmed by real-time polymerase chain reaction (PCR). Patients were categorized as symptomatic or asymptomatic, and the correlation between vitamin D levels and symptom severity was analyzed.

RESULTS

The findings demonstrated that a significant proportion of symptomatic patients had vitamin D levels below 20 ng/mL. In contrast, approximately 25% of asymptomatic patients had vitamin D levels exceeding 30 ng/mL. Statistical analysis confirmed a significant association between low vitamin D levels and increased symptom severity (p=0.007).

CONCLUSION

This study suggests that vitamin D deficiency may contribute to the severity of COVID-19 symptoms. Vitamin D supplementation could potentially reduce the risk of severe disease. However, to confirm these findings and support these recommendations, further research, including randomized controlled trials and large-scale population studies, is necessary.

Microneedling Radiofrequency for Acne Vulgaris in Adolescents as a Promising Device-Based Treatment: A Clinical Case Series

Background: Acne vulgaris is a persistent inflammatory condition affecting the sebaceous unit, in whose pathophysiology the Propionibacterium acnes (P. acnes) play an important role, and that can have major psychological effects. Objective: The current study aims to investigate the safety and efficacy of an innovative fractional microneedle radiofrequency (RFMN) device for acne management in adolescents. Materials and Methods: A total of 21 Caucasian young patients with facial acne of all grades of severity underwent three treatment sessions spaced 15/30 days apart with an RFMN device. The Acne Radar Questionnaire was administered to all patients. The data were represented using Radar graph, and the sample population was distributed in quartiles. The first quartile, the second quartile, and the third quartile were calculated for all patient populations before and at 6 months follow-up (6 MFU). The evaluation of the severity of acne lesions was assessed by using the Global Acne Severity scale. Photographs of patients with acne were acquired with a digital camera before and at 6 MFU after the last treatment session. Results: The mean values of each item of the Acne Radar Questionnaire significantly (p < 0.001) improved for all patients treated. The analyses obtained by the quartiles showed that all variables improved after the treatment with the study device. The photographic images confirm the positive results and the improvement of acne lesions. No major side effects were observed. Conclusions: The study system appears to be an effective and safe treatment choice for patients with inflammatory active acne and acne scarring.

Expanding access to maggot containment dressings through redesign and innovation

There are two major styles of maggot debridement dressings: (1) confinement dressings that form a cage around the wound, and (2) containment dressings that completely surround the maggots within a sealed porous bag. For producers and clinicians wanting to prepare containment dressings using readily available polyester bags, it is currently difficult to seal these bags without expensive high-temperature plastic welders. This study aimed to identify simple and affordable methods for sealing maggots within polyester net bags. Heat sealing was the most effective and simplest method to seal the polyester net bags, but the high melting point of polyester required industrial grade heat sealers. An inner lining of polyethylene or polypropylene film at the open side of the bag allowed for complete sealing using low-cost hand-actuated impulse heat sealers. This design even facilitated the addition of plastic zipper-locks, allowing secure closure of the bag without electricity or special equipment. Other sealing methods were identified, but most were time-consuming, required practice or not consistently successful. The maggot containment bag designs and closure methods described herein should prove useful to clinicians without access to contained maggots and to maggot producers without the resources to seal polyester containment bags. Clinical trials are expected to follow.