Cutaneous manifestations of myelodysplastic syndrome: A systematic review.

Myelodysplastic syndrome (MDS) may present with specific skin lesions, such as leukaemia cutis, which is a well known poor prognostic marker of leukaemia with a high risk of acute leukaemic transformation. However, less is known regarding non-specific cutaneous manifestations of MDS including the prevalence, types and their prognostic and therapeutic significance, which we aimed to determine through this systematic review. We searched electronic databases (PubMed, Medline and EMBASE) from inception up to 26 January 2023 for studies reporting cutaneous manifestations of MDS. Eighty eight articles (case reports n = 67, case series n = 21), consisting of 134 patients were identified. We identified 6 common cutaneous manifestations: neutrophilic dermatoses (n = 64), vasculitis (n = 21), granulomatous (n = 8), connective tissue disease (CTD) (n = 7; composed of dermatomyositis (n = 5), cutaneous lupus erythematosus (n = 1), and systemic sclerosis (n = 1)), panniculitis (n = 4), immunobullous (n = 1), and other (n = 29). Cutaneous features either occurred at time of MDS diagnosis in 25.3%, preceding the diagnosis in 34.7% (range 0.5-216 months), or after diagnosis in 40.0% (range 1-132 months). Prognosis was poor (40.2% death) with 34.1% progressing to acute myeloid leukaemia (AML). 50% of those with MDS who progressed to AML had neutrophilic dermatoses (p = 0.21). Myelodysplastic syndrome was fatal in 39.2% of neutrophilic dermatoses (median time from onset of cutaneous manifestation: 12 months), 50% of vasculitis (7.5 months), 62.5% of granulomatous (15.5 months) and 14.3% of CTD (7 months). Recognition of patterns of cutaneous features in MDS will improve early diagnosis and risk stratification according to subtype and associated prognosis.

Disseminated Bisifusarium infection following toxic epidermal necrolysis in a child with B-cell acute lymphoblastic leukemia.

Fusarium is a polyphyletic genus of plant pathogens, members of which can cause opportunistic human infections with varying superficial and systemic presentations, including disseminated infections which typically occur in immunocompromised patients and have a poor prognosis. Treatment is challenging due to intrinsic resistance to many antifungal agents, and antifungal susceptibility testing is therefore essential. Early suspicion, isolation of the organism, and prompt initiation of management are crucial to improving survival. We present a case of disseminated Bisifusarium infection following toxic epidermal necrolysis in a child with B-cell acute lymphoblastic leukemia, successfully treated with liposomal amphotericin B, voriconazole, flucytosine, and terbinafine.

Relative Performance of Machine Learning and Linear Regression in Predicting Quality of Life and Academic Performance of School Children in Norway: Data Analysis of a Quasi-Experimental Study.

BACKGROUND: Machine learning techniques are increasingly being applied in health research. It is not clear how useful these approaches are for modeling continuous outcomes. Child quality of life is associated with parental socioeconomic status and physical activity and may be associated with aerobic fitness and strength. It is unclear whether diet or academic performance is associated with quality of life. OBJECTIVE: The purpose of this study was to compare the predictive performance of machine learning techniques with that of linear regression in examining the extent to which continuous outcomes (physical activity, aerobic fitness, muscular strength, diet, and parental education) are predictive of academic performance and quality of life and whether academic performance and quality of life are associated. METHODS: We modeled data from children attending 9 schools in a quasi-experimental study. We split data randomly into training and validation sets. Curvilinear, nonlinear, and heteroscedastic variables were simulated to examine the performance of machine learning techniques compared to that of linear models, with and without imputation. RESULTS: We included data for 1711 children. Regression models explained 24% of academic performance variance in the real complete-case validation set, and up to 15% in quality of life. While machine learning techniques explained high proportions of variance in training sets, in validation, machine learning techniques explained approximately 0% of academic performance and 3% to 8% of quality of life. With imputation, machine learning techniques improved to 15% for academic performance. Machine learning outperformed regression for simulated nonlinear and heteroscedastic variables. The best predictors of academic performance in adjusted models were the child's mother having a master-level education (P<.001; ß=1.98, 95% CI 0.25 to 3.71), increased television and computer use (P=.03; ß=1.19, 95% CI 0.25 to 3.71), and dichotomized self-reported exercise (P=.001; ß=2.47, 95% CI 1.08 to 3.87). For quality of life, self-reported exercise (P<.001; ß=1.09, 95% CI 0.53 to 1.66) and increased television and computer use (P=.002; ß=-0.95, 95% CI -1.55 to -0.36) were the best predictors. Adjusted academic performance was associated with quality of life (P=.02; ß=0.12, 95% CI 0.02 to 0.22). CONCLUSIONS: Linear regression was less prone to overfitting and outperformed commonly used machine learning techniques. Imputation improved the performance of machine learning, but not sufficiently to outperform regression. Machine learning techniques outperformed linear regression for modeling nonlinear and heteroscedastic relationships and may be of use in such cases. Regression with splines performed almost as well in nonlinear modeling. Lifestyle variables, including physical exercise, television and computer use, and parental education are predictive of academic performance or quality of life. Academic performance is associated with quality of life after adjusting for lifestyle variables and may offer another promising intervention target to improve quality of life in children.

Leukotriene receptor antagonists for eczema.

BACKGROUND: Eczema is a common, chronic, inflammatory skin condition that is frequently associated with atopic conditions, including asthma. Leukotriene receptor antagonists (LTRAs) have a corticosteroid-sparing role in asthma, but their role in eczema remains controversial. Currently available topical therapies for eczema are often poorly tolerated, and use of systemic agents is restricted by their adverse effect profile. A review of alternative treatments was therefore warranted. OBJECTIVES: To assess the possible benefits and harms of leukotriene receptor antagonists for eczema. SEARCH METHODS: We searched the following databases to September 2017: the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and the GREAT database. We also searched five trial registries, and handsearched the bibliographies of all extracted studies for further relevant trials. SELECTION CRITERIA: Randomised controlled trials of LTRAs alone or in combination with other (topical or systemic) treatments compared with other treatments alone such as topical corticosteroids or placebo for eczema in the acute or chronic (maintenance) phase of eczema in adults and children. DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by Cochrane. The primary outcome measures were change in disease severity, long-term symptom control, and adverse effects of treatment. Secondary outcomes were change in corticosteroid requirement, reduction of pruritis, quality of life, and emollient requirement. We used GRADE to assess the quality of the evidence for each outcome. MAIN RESULTS: Only five studies (including a total of 202 participants) met the inclusion criteria, all of which assessed oral montelukast; hence, we found no studies assessing other LTRAs. Treatment ranged from four to eight weeks, and outcomes were assessed at the end of treatment; therefore, we could only report short-term measurements (defined as less than three months follow-up from baseline). Montelukast dosing was 10 mg for adults (age 14 years and above) and 5 mg for children (age 6 years to 14 years). One study included children (aged 6 years and above) among their participants, while the remaining studies only included adults (participant age ranged from 16 to 70 years). The participants were diagnosed with moderate-to-severe eczema in four studies and moderate eczema in one study. The study setting was unclear in two studies, multicentre in two studies, and single centre in one study; the studies were conducted in Europe and Bangladesh. Two studies were industry funded. The comparator was placebo in three studies and conventional treatment in two studies. The conventional treatment comparator was a combination of antihistamines and topical corticosteroids (plus oral antibiotics in one study).Four of the studies did not adequately describe their randomisation or allocation concealment method and were considered as at unclear risk of selection bias. Only one study was at low risk of performance and detection bias. However, we judged all studies to be at low risk of attrition and reporting bias.We found no evidence of a difference in disease severity of moderate-to-severe eczema after short-term use of montelukast (10 mg) when compared with placebo. The outcome was assessed using the modified EASI (Eczema Area and Severity Index) score and SASSAD (Six Area, Six Sign Atopic Dermatitis) severity score (standardised mean difference 0.29, with a positive score showing montelukast is favoured, 95% confidence interval (CI) -0.23 to 0.81; 3 studies; n = 131; low-quality evidence).When short-term montelukast (10 mg) treatment was compared with conventional treatment in one study, the mean improvement in severity of moderate-to-severe eczema was greater in the intervention group (measured using SCORAD (SCORing of Atopic Dermatitis) severity index) (mean difference 10.57, 95% CI 4.58 to 16.56; n = 31); however, another study of 32 participants found no significant difference between groups using the same measure (mean improvement was 25.2 points with montelukast versus 23.9 points with conventional treatment; no further numerical data provided). We judged the quality of the evidence as very low for this outcome, meaning the results are uncertain.All studies reported their adverse event rate during treatment. Four studies (136 participants) reported no adverse events. In one study of 58 participants with moderate eczema who received montelukast 10 mg (compared with placebo), there was one case of septicaemia and one case of dizziness reported in the intervention group, both resulting in study withdrawal, although whether these effects were related to the medication is unclear. Mild side effects (e.g. headache and mild gastrointestinal disturbances) were also noted, but these were fairly evenly distributed between the montelukast and placebo groups. The quality of evidence for this outcome was low.No studies specifically evaluated emollient requirement or quality of life. One study that administered treatment for eight weeks specifically evaluated pruritus improvement at the end treatment and topical corticosteroid use during treatment. We found no evidence of a difference between montelukast (10 mg) and placebo for both outcomes (low-quality evidence, n = 58). No other study assessed these outcomes. AUTHORS' CONCLUSIONS: The findings of this review are limited to montelukast. There was a lack of evidence addressing the review question, and the quality of the available evidence for most of the measured outcomes was low. Some primary and secondary outcomes were not addressed at all, including long-term control.We found no evidence of a difference between montelukast (10 mg) and placebo on disease severity, pruritus improvement, and topical corticosteroid use. Very low-quality evidence means we are uncertain of the effect of montelukast (10 mg) compared with conventional treatment on disease severity. Participants in only one study reported adverse events, which were mainly mild (low-quality evidence).There is no evidence that LTRA is an effective treatment for eczema. Serious limitations were that all studies focused on montelukast and only included people with moderate-to-severe eczema, who were mainly adults; and that each outcome was evaluated with a small sample size, if at all.Further large randomised controlled trials, with a longer treatment duration, of adults and children who have eczema of all severities may help to evaluate the effect of all types of LTRA, especially on eczema maintenance.

Spectrum and burden of dermatophytes in children.

Tinea capitis is the most important superficial fungal condition in children. It is often unrecognised but the presence of alopecia, scale and lymphadenopathy, especially in inner-city children should prompt investigation. An understanding of changing epidemiology and prevalence of causative organisms is important in deciding appropriate therapy. The use of diagnostic aids including dermoscopy is increasing and is reported to be helpful in identifying subtle signs. Trichophyton tonsurans accounts for the majority of cases in the UK and terbinafine is increasingly advocated as a safe and effective therapy. Exclusion from school is unnecessary provided the child is receiving appropriate systemic and topical therapy, but family members should be screened and carriers should receive treatment. Steroids and surgical treatments should be avoided. Treatment failure is common and may be multifactorial. Mycological cure after completing treatment should be sought and therefore follow up is necessary for Tinea capitis cases. Development of molecular diagnostic methods may improve our ability to diagnose Tinea capitis accurately and quickly in the future. Emerging new dermatophytoses affecting other anatomical sites are discussed which, although not common in the UK, may be seen due to increasing travel worldwide.

The integration and evaluation of a social-media facilitated journal club to enhance the student learning experience of evidence-based practice: A case study.

INTRODUCTION: Nurses are required to interpret and apply knowledge so communities will receive care based on best available evidence, as opposed to care that is simply based on tradition or authority. Fostering nursing students' critical appraisal skills will assist in their capacity to engage with, interpret and use best evidence. Journal clubs are frequently used approach to engage learners with research and develop critical appraisal skills. Given new flipped and blended approaches to teaching and learning there is need to rejuvenate how research is utilised and integrated within journal clubs to maximise engagement and translation of evidence. PURPOSE: This paper provides a case study of a single site Australian university experience of transitioning a traditional physical journal club, to a social media-facilitated club within a postgraduate health subject to stimulate and facilitate engagement with the chosen manuscripts. DATA SOURCES: This case study is based on our own experiences, supported by literature and includes qualitative comments obtained via student feedback surveys during November 2015. DESIGN: Case study. IMPLICATIONS FOR NURSING AND CONCLUSION: Social media-facilitated journal clubs offer an efficient way to continue developing critical appraisal skills in nursing students. The integration of a social media-facilitated journal clubs increased student attention, engagement with presented activities and overall student satisfaction within this evidence-based practice subject. Future rigorously-designed, large-scale studies are required to evaluate the impact of online journal clubs on the uptake of evidence-based practice, including those resulting in improved patient outcomes.

Students working with multiple conflicting documents on a scientific issue: relations between epistemic cognition while reading and sourcing and argumentation in essays.

BACKGROUND: There is burgeoning research within educational psychology on both epistemic cognition and multiple-documents literacy, as well as on relationships between the two constructs. AIM: To examine relationships between epistemic cognition concerning the justification of knowledge claims and sourcing and argumentation skills. SAMPLE: Participants were 51 Norwegian undergraduates. METHOD: Three dimensions of justification were identified in think-aloud protocols based on students' reading of six documents presenting conflicting claims on the controversial scientific issue of cell phone radiation and health risks: justification by authority, personal justification and justification by multiple sources. Hierarchical multiple regression analyses were performed to examine the unique predictability of these dimensions for essay performance after removing variance associated with prior knowledge about the topic of the documents. RESULTS: After controlling for topic knowledge, justification by multiple sources uniquely predicted students' sourcing and argumentation in essays that they wrote after reading the documents, with students trying to justify knowledge claims by corroborating across several sources of information more likely to include explicit source citations, link sources and contents, and display better, more integrated argumentation in their essays. CONCLUSION: Findings are considered in the light of a theoretical framework for multiple-documents literacy adapted to the domain of science, and both theoretical and educational implications are discussed.

Radiotherapy treatment of keloid scars with a kilovoltage X-ray parallel pair.

An established treatment for keloids is surgery and radiotherapy, using a single applied field. However, earlobe keloids lend themselves to a parallel opposed pair approach. Delivery with a superficial X-ray unit is practicable and improves homogeneity within the treatment volume. It has been implemented in this centre since 2007.