Acral milia-like idiopathic calcinosis cutis in a child with down syndrome: report of a case, review of the literature, and description of dermoscopic findings.

Milia-like idiopathic calcinosis cutis (MICC) is a rare dermopathy, usually occurring in children with Down syndrome. We report a case of an 8-year-old girl with Down syndrome who presented with histologically verified MICC, briefly review the literature on MICC, discuss the differential diagnosis, and describe the use of dermoscopy in the evaluation of lesions, which we believe has never been published previously with this entity.

Assessment of a Smartphone-Based Loop-Mediated Isothermal Amplification Assay for Detection of SARS-CoV-2 and Influenza Viruses.

Importance: A critical need exists in low-income and middle-income countries for low-cost, low-tech, yet highly reliable and scalable testing for SARS-CoV-2 virus that is robust against circulating variants. Objective: To assess whether a smartphone-based assay is suitable for SARS-CoV-2 and influenza virus testing without requiring specialized equipment, accessory devices, or custom reagents. Design, Setting, and Participants: This cohort study enrolled 2 subgroups of participants (symptomatic and asymptomatic) at Santa Barbara Cottage Hospital. The symptomatic group consisted of 20 recruited patients who tested positive for SARS-CoV-2 with symptoms; 30 asymptomatic patients were recruited from the same community, through negative admission screening tests for SARS-CoV-2. The smartphone-based real-time loop-mediated isothermal amplification (smaRT-LAMP) was first optimized for analysis of human saliva samples spiked with either SARS-CoV-2 or influenza A or B virus; these results then were compared with those obtained by side-by-side analysis of spiked samples using the Centers for Disease Control and Prevention (CDC) criterion-standard reverse transcriptase-quantitative polymerase chain reaction (RT-qPCR) assay. Next, both assays were used to test for SARS-CoV-2 and influenza viruses present in blinded clinical saliva samples obtained from 50 hospitalized patients. Statistical analysis was performed from May to June 2021. Exposures: Testing for SARS-CoV-2 and influenza A and B viruses. Main Outcomes and Measures: SARS-CoV-2 and influenza infection status and quantitative viral load were determined. Results: Among the 50 eligible participants with no prior SARS-CoV-2 infection included in the study, 29 were men. The mean age was 57 years (range, 21 to 93 years). SmaRT-LAMP exhibited 100% concordance (50 of 50 patient samples) with the CDC criterion-standard diagnostic for SARS-CoV-2 sensitivity (20 of 20 positive and 30 of 30 negative) and for quantitative detection of viral load. This platform also met the CDC criterion standard for detection of clinically similar influenza A and B viruses in spiked saliva samples (n = 20), and in saliva samples from hospitalized patients (50 of 50 negative). The smartphone-based LAMP assay was rapid (25 minutes), sensitive (1000 copies/mL), low-cost (<$7/test), and scalable (96 samples/phone). Conclusions and Relevance: In this cohort study of saliva samples from patients, the smartphone-based LAMP assay detected SARS-CoV-2 infection and exhibited concordance with RT-qPCR tests. These findings suggest that this tool could be adapted in response to novel CoV-2 variants and other pathogens with pandemic potential including influenza and may be useful in settings with limited resources.

Smartphone-based pathogen diagnosis in urinary sepsis patients.

BACKGROUND: There is an urgent need for rapid, sensitive, and affordable diagnostics for microbial infections at the point-of-care. Although a number of innovative systems have been reported that transform mobile phones into potential diagnostic tools, the translational challenge to clinical diagnostics remains a significant hurdle to overcome. METHODS: A smartphone-based real-time loop-mediated isothermal amplification (smaRT-LAMP) system was developed for pathogen ID in urinary sepsis patients. The free, custom-built mobile phone app allows the phone to serve as a stand-alone device for quantitative diagnostics, allowing the determination of genome copy-number of bacterial pathogens in real time. FINDINGS: A head-to-head comparative bacterial analysis of urine from sepsis patients revealed that the performance of smaRT-LAMP matched that of clinical diagnostics at the admitting hospital in a fraction of the time (~1 h vs. 18-28 h). Among patients with bacteremic complications of their urinary sepsis, pathogen ID from the urine matched that from the blood - potentially allowing pathogen diagnosis shortly after hospital admission. Additionally, smaRT-LAMP did not exhibit false positives in sepsis patients with clinically negative urine cultures. INTERPRETATION: The smaRT-LAMP system is effective against diverse Gram-negative and -positive pathogens and biological specimens, costs less than $100 US to fabricate (in addition to the smartphone), and is configurable for the simultaneous detection of multiple pathogens. SmaRT-LAMP thus offers the potential to deliver rapid diagnosis and treatment of urinary tract infections and urinary sepsis with a simple test that can be performed at low cost at the point-of-care. FUND: National Institutes of Health, Chan-Zuckerberg Biohub, Bill and Melinda Gates Foundation.

Traction folliculitis: an underreported entity.

Traction folliculitis is a component of traction alopecia syndrome and has received minimal attention in primary source medical literature. The popularity of hairstyles that produce hair traction and the knowledge that early intervention improves prognosis amplify the importance of recognizing this entity. Traction folliculitis presents as perifollicular erythema and pustules on the scalp in areas where hairstyles produce traction on the hair shaft. In addition to the traction, concurrent hair care practices may play a facilitatory role in the development of traction folliculitis. Treatment involves immediate removal of traction on hair and temporary alteration of the facilitatory hair care practices. In more severe cases, topical or systemic antibacterial therapy and, occasionally, topical corticosteroid therapy may be necessary. Failure to discontinue traction-producing hairstyles can lead to traction alopecia and irreversible hair loss. Cultural considerations often are paramount in hairstyle choices and hair care practices that cause predisposition to traction disorders. Thus, culturally competent counseling requires understanding the significance of the hairstyle and hair care practices to the patient (or caregivers), discussing the recommendations in a culturally sensitive manner, and negotiating mutually acceptable alternative practices.

Extensive lichenoid drug eruption due to glyburide: a case report and review of the literature.

Lichenoid reactions to sulfonylurea drugs have been reported, albeit infrequently. To our knowledge, this is the first case of a generalized lichenoid dermatitis likely induced by the third-generation sulfonylurea hypoglycemic drug glyburide.