Pathohistological features of the aging human lacrimal gland.

AIM: To assess sex-related differences in the pathohistological features of the human lacrimal gland and to investigate age-related and sex-related differences in stereologically measured volume density of the secretory tissue, connective tissue, and fat. METHODS: We performed an observational analysis of acinar atrophy, periacinar fibrosis, periductal fibrosis, ductal dilation, ductal proliferation, fatty infiltration, and lymphocyte infiltration of hematoxylin and eosin-stained lacrimal gland samples from 81 cornea donors. Stereological analysis of the volume density of the secretory tissue, connective tissue, and fat was performed on samples from 66 donors. RESULTS: Up to 69% of all samples showed degenerative changes. Female samples had a higher frequency of all observed degenerative changes, except ductal dilation. While acinar atrophy was significantly more prevalent in women, ductal dilation was significantly more prevalent in men. Stereological analysis indicated lower portions of acini and higher portions of connective tissue and fat, as well as a more pronounced age-related progression of degenerative changes in female samples. CONCLUSION: Female lacrimal glands are more susceptible to degeneration, and this susceptibility could play an important role in the higher incidence of dry eye disease in older women. A further stereological analysis using more samples from younger age groups is needed to elucidate age-related and sex-related differences in the structure of the human lacrimal gland and their impact on dry eye disease.

Expression of Androgen and Estrogen Receptors in the Human Lacrimal Gland.

Lacrimal gland dysfunction causes dry eye disease (DED) due to decreased tear production. Aqueous-deficient DED is more prevalent in women, suggesting that sexual dimorphism of the human lacrimal gland could be a potential cause. Sex steroid hormones are a key factor in the development of sexual dimorphism. This study aimed to quantify estrogen receptor (ER) and androgen receptor (AR) expression in the human lacrimal gland and compare it between sexes. RNA was isolated from 35 human lacrimal gland tissue samples collected from 19 cornea donors. AR, ERα, and ERß mRNA was identified in all samples, and their expression was quantified using qPCR. Immunohistochemical staining was performed on selected samples to evaluate protein expression of the receptors. ERα mRNA expression was significantly higher than the expression of AR and ERß. No difference in sex steroid hormone (SSH) receptor mRNA expression was observed between sexes, and no correlation was observed with age. If ERα protein expression is found to be concordant with mRNA expression, it should be investigated further as a potential target for hormone therapy of DED. Further research is needed to elucidate the role of sex steroid hormone receptors in sex-related differences of lacrimal gland structure and disease.

Necrotic Cells from Head and Neck Carcinomas Release Biomolecules That Are Activating Toll-like Receptor 3.

Tumor necrosis is a recurrent characteristic of head and neck squamous cell carcinomas (HNSCCs). There is a need for more investigations on the influence of biomolecules released by these necrotic foci in the HNSCC tumor microenvironment. It is suspected that a fraction of the biomolecules released by necrotic cells are damage-associated molecular patterns (DAMPs), which are known to be natural endogenous ligands of Toll-like receptors (TLRs), including, among others, proteins and nucleic acids. However, there has been no direct demonstration that biomolecules released by HNSCC necrotic cells can activate TLRs. Our aim was to investigate whether some of these molecules could behave as agonists of the TLR3, either in vitro or in vivo. We chose a functional approach based on reporter cell exhibiting artificial TLR3 expression and downstream release of secreted alkaline phosphatase. The production of biomolecules activating TLR3 was first investigated in vitro using three HNSCC cell lines subjected to various pronecrotic stimuli (external irradiation, serum starvation, hypoxia and oxidative stress). TLR3 agonists were also investigated in necrotic tumor fluids from five oral cancer patients and three mouse tumor grafts. The release of biomolecules activating TLR3 was demonstrated for all three HNSCC cell lines. External irradiation was the most consistently efficient stimulus, and corresponding TLR3 agonists were conveyed in extracellular vesicles. TLR3-stimulating activity was detected in the fluids from all five patients and three mouse tumor grafts. In most cases, this activity was greatly reduced by RNAse pretreatment or TLR3 blocking antibodies. Our data indicate that TLR3 agonists are consistently present in necrotic fluids from HNSCC cells and mainly made of dsRNA fragments. These endogenous agonists may induce TLR3, which might lead to a protumorigenic effect. Regarding methodological aspects, our study demonstrates that direct investigations-including functional testing-can be performed on necrotic fluids from patient tumors.

Predictors of Satisfaction with Care in Patients Suffering from Schizophrenia Treated Under Community Mental Health Teams.

The aim of this study was to assess satisfaction with care and to identify the predictors of this variable among sociodemographic, clinical and social data in a group of patients suffering from schizophrenia under treatment in community mental health teams. The study included 90 patients with a diagnosis of schizophrenia under the care of community mental health teams. Positive and Negative SyndromeScale, Verona Service Satisfaction Scale, Disability Assessment Schedule, Social Network Index and a loneliness scale (UCLA Loneliness Scale)were used in the study. Prognostic factors for higher satisfaction with care in the multivariate model involved: level of disability (Beta = -0.46, p < 0.001), duration of treatment under a CMHT (Beta = 0.36, p < 0.001), age (Beta = -0.37,p < 0.001), and education (Beta = -0.30, p = 0.002). The model explained 43% of the variance in the dependent variable. 1.Satisfaction with care in a CMHT was high. 2. Higher patient satisfaction could be predicted based on a lower level of disability, longer duration of treatment under a CMHT, lower age and lower education.

Frequency drift in MR spectroscopy at 3T.

PURPOSE: Heating of gradient coils and passive shim components is a common cause of instability in the B0 field, especially when gradient intensive sequences are used. The aim of the study was to set a benchmark for typical drift encountered during MR spectroscopy (MRS) to assess the need for real-time field-frequency locking on MRI scanners by comparing field drift data from a large number of sites. METHOD: A standardized protocol was developed for 80 participating sites using 99 3T MR scanners from 3 major vendors. Phantom water signals were acquired before and after an EPI sequence. The protocol consisted of: minimal preparatory imaging; a short pre-fMRI PRESS; a ten-minute fMRI acquisition; and a long post-fMRI PRESS acquisition. Both pre- and post-fMRI PRESS were non-water suppressed. Real-time frequency stabilization/adjustment was switched off when appropriate. Sixty scanners repeated the protocol for a second dataset. In addition, a three-hour post-fMRI MRS acquisition was performed at one site to observe change of gradient temperature and drift rate. Spectral analysis was performed using MATLAB. Frequency drift in pre-fMRI PRESS data were compared with the first 5:20 minutes and the full 30:00 minutes of data after fMRI. Median (interquartile range) drifts were measured and showed in violin plot. Paired t-tests were performed to compare frequency drift pre- and post-fMRI. A simulated in vivo spectrum was generated using FID-A to visualize the effect of the observed frequency drifts. The simulated spectrum was convolved with the frequency trace for the most extreme cases. Impacts of frequency drifts on NAA and GABA were also simulated as a function of linear drift. Data from the repeated protocol were compared with the corresponding first dataset using Pearson's and intraclass correlation coefficients (ICC). RESULTS: Of the data collected from 99 scanners, 4 were excluded due to various reasons. Thus, data from 95 scanners were ultimately analyzed. For the first 5:20 min (64 transients), median (interquartile range) drift was 0.44 (1.29) Hz before fMRI and 0.83 (1.29) Hz after. This increased to 3.15 (4.02) Hz for the full 30 min (360 transients) run. Average drift rates were 0.29 Hz/min before fMRI and 0.43 Hz/min after. Paired t-tests indicated that drift increased after fMRI, as expected (p < 0.05). Simulated spectra convolved with the frequency drift showed that the intensity of the NAA singlet was reduced by up to 26%, 44 % and 18% for GE, Philips and Siemens scanners after fMRI, respectively. ICCs indicated good agreement between datasets acquired on separate days. The single site long acquisition showed drift rate was reduced to 0.03 Hz/min approximately three hours after fMRI. DISCUSSION: This study analyzed frequency drift data from 95 3T MRI scanners. Median levels of drift were relatively low (5-min average under 1 Hz), but the most extreme cases suffered from higher levels of drift. The extent of drift varied across scanners which both linear and nonlinear drifts were observed.

Feedbacks, Bifurcations, and Cell Fate Decision-Making in the p53 System.

The p53 transcription factor is a regulator of key cellular processes including DNA repair, cell cycle arrest, and apoptosis. In this theoretical study, we investigate how the complex circuitry of the p53 network allows for stochastic yet unambiguous cell fate decision-making. The proposed Markov chain model consists of the regulatory core and two subordinated bistable modules responsible for cell cycle arrest and apoptosis. The regulatory core is controlled by two negative feedback loops (regulated by Mdm2 and Wip1) responsible for oscillations, and two antagonistic positive feedback loops (regulated by phosphatases Wip1 and PTEN) responsible for bistability. By means of bifurcation analysis of the deterministic approximation we capture the recurrent solutions (i.e., steady states and limit cycles) that delineate temporal responses of the stochastic system. Direct switching from the limit-cycle oscillations to the "apoptotic" steady state is enabled by the existence of a subcritical Neimark-Sacker bifurcation in which the limit cycle loses its stability by merging with an unstable invariant torus. Our analysis provides an explanation why cancer cell lines known to have vastly diverse expression levels of Wip1 and PTEN exhibit a broad spectrum of responses to DNA damage: from a fast transition to a high level of p53 killer (a p53 phosphoform which promotes commitment to apoptosis) in cells characterized by high PTEN and low Wip1 levels to long-lasting p53 level oscillations in cells having PTEN promoter methylated (as in, e.g., MCF-7 cell line).

Enhancing stewardship of community-engaged research through governance.

OBJECTIVES: We explored the relationship of community-engaged research final approval type (tribal government, health board, or public health office (TG/HB); agency staff or advisory board; or individual or no community approval) with governance processes, productivity, and perceived outcomes. METHODS: We identified 294 federally funded community-engaged research projects in 2009 from the National Institutes of Health's Research Portfolio Online Reporting Tools, Centers for Disease Control and Prevention's Prevention Research Centers, and Native American Research Centers for Health databases. Two hundred (68.0%) investigators completed a survey about governance processes and productivity measures; 312 partners (77.2% of 404 invited) and 138 investigators (69.0% of 200 invited) completed a survey about perceived outcomes. RESULTS: Projects with TG/HB approval had increased likelihood of community control of resources (odds ratios [ORs] ≥ 4.80). Projects with other approvals had decreased likelihood of development or revision of institutional review board policies (ORs ≤ 0.37), having written agreements (ORs ≤ 0.17), and agreements about publishing (ORs ≤ 0.28), data use (ORs ≤ 0.17), and publishing approval (ORs ≤ 0.14). CONCLUSIONS: Community-engaged research projects with TG/HB approval had strong stewardship of project resources and agreements. Governance as stewardship protects community interests; thus, is an ethical imperative for communities, especially native communities, to adopt.

Mastoid trepanation in a deceased from medieval Croatia: a case report.

We present a rare case of infratentorial mastoid trepanation, by drilling, from medieval Croatia. An artificial ante-mortal opening was found in a male skeleton from the 11th century cemetery Zvonimirovo. It was placed roughly at the intersection of the Frankfurt's plane and the midline of the right mastoid. The right posterior parietal of the deceased also exhibited a callus-like formation consistent with the linear cranial fracture. Our aim was to investigate by computed tomography (CT) a possible presence of otopathology--a chronic middle ear infection--MEI/mastoiditis or cholesteatoma. On the other hand, both standard radiography and CT were employed in a cranial fracture diagnostic agreement. The generated CT scans confirmed the presence of an artificial hole running into a well defined trepanne canal connected with the antrum. The presence of otopathology was not established. The radiography and CT substantiated the presence of a linear posterior parietal discontinuity--without displacement, in front of the right lambdoid suture. From the medical point of view, it would be unusual to perform infratentorial--mastoid trepanation for reasons of treating supratentorial trauma, i.e. possible posttraumatic acute subdural hematoma (PTASDH). However, since there was a lack of CT evidence of osteolysis in ME, there is a possibility of medieval trepanation procedure performed for reasons of posttraumatic treat- ment. To our best knowledge, usually, ancient trepanations described in Croatian bioarchaeology and all over the world are supratentorial and do not always reveal such sophisticated surgical techniques.

GM-CSF-loaded chitosan hydrogel as an immunoadjuvant enhances antigen-specific immune responses with reduced toxicity.

BACKGROUND: The application of vaccine adjuvants has been vigorously studied for a diverse range of diseases in order to improve immune responses and reduce toxicity. However, most adjuvants have limited uses in clinical practice due to their toxicity. METHODS: Therefore, to reduce health risks associated with the use of such adjuvants, we developed an advanced non-toxic adjuvant utilizing biodegradable chitosan hydrogel (CH-HG) containing ovalbumin (OVA) and granulocyte-macrophage colony-stimulating factor (GM-CSF) as a local antigen delivery system. RESULTS: After subcutaneous injection into mice, OVA/GM-CSF-loaded CH-HG demonstrated improved safety and enhanced OVA-specific antibody production compared to oil-based adjuvants such as Complete Freund's adjuvant (CFA) or Incomplete Freund's adjuvant (IFA). Moreover, CH-HG system-mediated immune responses was characterized by increased number of OVA-specific CD4(+) and CD8(+) INF-γ(+) T cells, leading to enhanced humoral and cellular immunity. CONCLUSIONS: In this study, the improved safety and enhanced immune response characteristics of our novel adjuvant system suggest the possibility of the extended use of adjuvants in clinical practice with reduced apprehension about toxic side effects.

Outbreak investigation of Dengue fever in Sundia, Chakaiser, Shangla, Pakistan-2008.

BACKGROUND: From October 1-6, 2008 media reported increased fever cases along-with some deaths in a village that were found positive for dengue IgM antibody. The provincial health authorities ordered an investigation. Our investigation aimed to determine the magnitude of disease, understand the epidemiological characteristics, and recommend preventive measures. METHODS: The study was to investigate an epidemic through a descriptive study followed by a case-control study in the village Sundia from October 14th to Nov 2nd, 2008. A case defined as: "Anyone from the village with fever and any one of the symptoms including bone breaking fever (arthralgia, myalgia), rash, bleeding from nose and gums from 21st Sept 2008 to 2nd Nov 2008. For comparison, controls (n=183) i.e., those who did not fulfil the case definition criteria: Systematic random sampling technique was used and data was collected on a pro forma. Blood samples were also collected from those who had fever for the last 3 days or more. RESULTS: A total of 113 (33%) households were surveyed out of 339 among which 156 (46%) cases were selected based on case definition and all the rest (183) were taken as controls. There were 84 (54%) males and 72 (46%) females. Mean age was 30 (range between 1-80 years). Beside fever, other predominant symptoms were joint pains 94 (60%) and headache 91 (58%). Seventy samples were collected and tested for dengue IgM on ELISA method and 12 (17.14%) were found positive. Logistic regression was done and uncovered water containers (p-value <0.05) to (adjusted OR=1.8; p-=0.008), surrounding marshy land (p=0.03) to (adjusted OR=1.75; p=0.02) & tap water (p=0.001) to (adjusted OR=3.2964; p=0.0012) were found to be associated with the fever. CONCLUSIONS: Investigation showed presence of different risk factors which also pertain to other countries. The gaps in communication lead to the increased number of fever cases. Dengue prevention and control program, capacity building and a strong surveillance system is crucial.

'It's a Horrible Place to Have a Period': A Survivor-Led Investigation of Experiences of Menstrual Health in Psychiatric Inpatient Settings in England.

This study examined patients' experiences of menstrual health in psychiatric inpatient settings in England as reported by staff and patients. Questionnaires were conducted with 67 staff members and 101 people with lived experience of menstruation and treatment on a psychiatric ward. 10 semi-structured interviews were conducted with people with lived experience. Data were analysed using reflexive thematic analysis. Grouped into overarching themes of institutional and interpersonal environments, four themes were identified: access to menstrual materials; the lack of privacy when menstruating in psychiatric inpatient settings; attitudes and approaches to menstruation; and menstrual support needs and care provision. There was variation among the experiences reported, with some patients receiving dignified care, whilst others described facing 'degrading' and 'dehumanising' treatments and enhanced feelings of shame and embarrassment around menstruation, in comparison with what they usually experience. This appeared to arise due to the interplay between mental health services overlooking menstruation and the overreliance on restrictive practices. These experiences may be understood as menstrual injustices, period poverty, potentially amounting to neglect and posing iatrogenic harms. Participants also discussed how their mental illness and distress, particularly within the context of trauma and/or eating disorders, shaped their menstrual experiences. However, many patients did not receive adequate support in relation to this. Patients' pain and disorder related to menstruation, or gynaecological conditions, was often described as being dismissed by staff or being viewed as beyond the responsibility of mental health services. This study highlighted the urgency for actions to be taken to provide greater support for patients who menstruate in psychiatric inpatient settings.

Effect of alcohol abuse on selected markers of inflammation, hemostasis, and endothelial function.

BACKGROUND: Alcohol consumption, even in moderate amounts, is associated with complex changes in blood biochemistry, involving abnormalities of many markers affecting cardiovascular risk. METHODS: A total of 100 patients with documented alcohol abuse were included in the study. Demographic data and information on alcohol consumption were collected using a standardized questionnaire. All patients underwent biochemical tests. The following parameters were evaluated: PAI-1, vWF, TNF-α, VCAM-1, adiponectin, fibrinogen, lipid profile, and hsCRP. The results were compared with a control group of 25 healthy subjects. RESULTS: A significant adverse effect of alcohol abuse was observed for markers such as PAI-1, TNF-α, VCAM-1, adiponectin, and fibrinogen. Moreover, most of the subjects showed elevated TC, LDL-C, and TG levels. There was a significant relationship between vWF and average daily alcohol consumption, a positive relationship between adiponectin levels and age, and between fibrinogen and the number of cigarettes smoked. No significant correlations were observed between the other markers and age, gender, place of residence, daily alcohol consumption, and total time of alcohol abuse. CONCLUSIONS: Several abnormalities in most of the analyzed markers were observed in persons abusing alcohol, with no significant correlation with the daily amount of alcohol consumed and the total time of alcohol abuse, which may indicate permanent and irreversible damage to many tissues and organs as a result of chronic alcohol consumption. Further studies in this area with a larger group of patients are necessary to clarify the mechanisms leading to cardiovascular damage in the course of alcohol abuse.

Satisfaction with care in patients with schizophrenia treated in a pilot-program model and traditional care. / Satysfakcja z opieki u pacjentów chorujacych na schizofrenie w modelu pilotazowym i opiece tradycyjnej.

OBJECTIVES: The purpose of this study was to compare satisfaction with care in patients with schizophrenia in two CMHT models: traditional and pilot program group with concurrent assessment of symptom severity and social functioning. METHODS: Ninety patients with schizophrenia treated in Community Mental Health Teams were included in the study, 60 in the traditional model and 30 in the pilot-program model.A demographic data questionnaire, the Positive and Negative Syndrome Scale (PANSS), the Verona Service Satisfaction Scale (VSSS-54), the Disability Assessment Schedule (WHODAS), the Social Network Index (SNI),and a scale measuring loneliness (UCLA Loneliness Scale) were used. RESULTS: The pilot-program group was characterized by significantly lower age of subjects (p=0.048), less psychiatric medication use (p=0.027), higher total(p<0.001) and positive (p<0.001) symptom severity in PANSS, smaller social network (p=0.003), less role activity in social network (p<0.001), higher level of loneliness (p=0.001) and higher level of disability (p<0.001). The pilot-program group had significantly higher satisfaction with involvement of families in the therapeutic process(p = 0.024). CONCLUSIONS: In the pilot-program group, younger, more severely ill patients with higher severity of symptoms and worse social functioning were included in the treatment with no differences in the number of hospitalizations between the groups. It can be concluded that CMHT in the pilot-program Mental Health Centers (MHCs) protects this group of patients from hospitalization. There was also higher satisfaction with family involvement in the therapeutic process in the pilot-program group. A valuable continuation of the study would be to evaluate the treatment outcomes in all CMHTs operating under the pilot-program MHCs.

Burden of caregivers of people suffering from schizophrenia versus symptom severity, social functioning and treatment satisfaction of patients treated by a CMHT. / Obciazenie opiekunów osób chorujacych na schizofrenie a nasilenie objawów, funkcjonowanie spoleczne i satysfakcja z leczenia pacjentów leczonych w ZLS.

OBJECTIVES: This study aims to assess the caregivers' burden in schizophrenia amongst patients treated by Community Mental Health Teams (CMHTs) and its relation to patients' demographic, clinical and social characteristics, with emphasis on their satisfaction with care, and to evaluate the correlation of selected characteristics of caregivers with the level of their burden. METHODS: A total of 65 patient-caregiver dyads remaining in home treatment were included. Caregivers were assessed with demographic questionnaires, and the Caregiver Burden Inventory (CBI). The patients were assessed with the Positive and Negative Syndrome Scale (PANSS), the Verona Service Satisfaction Scale (VSSS-54), the Disability Assessment Schedule (WHODAS 2.0), the Social Network Index (SNI) and with the UCLA Loneliness Scale. Data were analysed using multiple linear regression. RESULTS: Increased caregiver burden was associated with: greater symptom severity in patients, lower satisfaction with staff professionalism, and a high level of emotional expressiveness in relationships. The regression model explaining 57% of the variance in the caregivers' emotional burden consisted of four factors: the patient's positive syndrome intensity, patient's remaining in an emotional relationship, gender i.e. higher burden amongst female caregivers of male patients, and smaller social network. CONCLUSIONS: The caregivers' burden severity is related to patients' sociodemographic, clinical and social characteristics and their satisfaction with treatment. The emotional burden of caregivers is impacted by: greater symptom severity, especially the positive syndrome, lower patient satisfaction with staff professionalism, and a high expression of emotions in family relationships. The patient's and caregiver's gender and education level, the patient's degree of disability, them being in a relationship and social support network size are also significant.

B cell activation triggered by the formation of the small receptor cluster: a computational study.

We proposed a spatially extended model of early events of B cell receptors (BCR) activation, which is based on mutual kinase-receptor interactions that are characteristic for the immune receptors and the Src family kinases. These interactions lead to the positive feedback which, together with two nonlinearities resulting from the double phosphorylation of receptors and Michaelis-Menten dephosphorylation kinetics, are responsible for the system bistability. We demonstrated that B cell can be activated by a formation of a tiny cluster of receptors or displacement of the nucleus. The receptors and Src kinases are activated, first locally, in the locus of the receptor cluster or the region where the cytoplasm is the thinnest. Then the traveling wave of activation propagates until activity spreads over the whole cell membrane. In the models in which we assume that the kinases are free to diffuse in the cytoplasm, we found that the fraction of aggregated receptors, capable to initiate B cell activation decreases with the decreasing thickness of cytoplasm and decreasing kinase diffusion. When kinases are restricted to the cell membrane - which is the case for most of the Src family kinases - even a cluster consisting of a tiny fraction of total receptors becomes activatory. Interestingly, the system remains insensitive to the modest changes of total receptor level. The model provides a plausible mechanism of B cells activation due to the formation of small receptors clusters collocalized by binding of polyvalent antigens or arising during the immune synapse formation.

Tonsillolithiasis and orofacial pain.

Tonsilloliths are rare calcified structures that usually result from chronic inflammation of the tonsils. Concretions show differences in size, shape and colour. They are usually asymptomatic but can be associated with halitosis, foreign body sensation, dysphagia and odynophagia, otalgia, and neck pain. A patient was referred because panoramic radiography performed by a general dentist revealed radiopaque shadows over the ascending rami of the mandible, located bilaterally: a solitary structure on the higher portion of the right side and two small structures on the left side. Paroxysmal attacks of orofacial pain and symptoms such as dysphagia and swallowing pain on the left side distributed within the tonsillar fossa and pharynx and the angle of the lower jaw were present. The computed tomography images revealed bilateral tonsilloliths. Clinically, there was no sign of inflammation, and the patient's past history revealed an approximately 2-year history of dysphagia, swallowing pain and left-sided neck pain. At the request of the patient, no surgical intervention was carried out. Glossopharyngeal neuralgia is a rare entity, and the aim of this report was to indicate the importance of tonsilloliths as a cause of orofacial pain.

Pathogenesis and treatment of skin lesions caused by sulfur mustard.

OBJECTIVE: Sulfur mustard (SM) exposure intensely causes lesions that range in severity from mild erythema to blister formation and necrosis. This review will discuss acute and long-term skin consequences due to exposure to SM and different kinds of medical prophylaxis and therapeutics against SM-induced skin lesions. METHODS: Literature survey of medical case reports, clinical studies, and original articles was performed using PubMed, Medline, and the Cochrane Database (1917-2011 March). Key words included sulfur mustard, skin, toxicity, pathogenesis, cancer, treatment. RESULTS: SM-induced damage to the skin is characterized by edema, inflammation, and cell death mainly of the basal keratinocyte layer, with varying immunological and pathological changes in the acute phase. Also, xerosis, hypo or hyper pigmentation, scars, and rarely, skin cancers are long-term cutaneous effects. So far,the combination therapy of topical drugs and oral antihistamines, also iodine and antitumor necrosis factor alpha antibodies, are effective remedies in the treatment of skin lesions. CONCLUSION: The requirement for preparedness in the dermatological community concerning SM exposure is underlined. Novel treatments for prevention and therapeutics against SM toxicity and carcinogenicity are reviewed.

Inflammatory pseudotumor presenting as a facial swelling.

We present a case of inflammatory pseudotumor (IPT) presenting as a facial swelling after an accidental hit on a right side of a face. As swelling did not resolve, dental examination and teeth extraction were done by a dentist presuming the swelling was misdiagnosed with infection of dental origin. Swelling grew even bigger and patient was referred to Department of Maxillofacial Surgery. CT scan of the face and FNA of the lesion was ordered. A homogenous tumor mass in the right infraorbital region in front of anterior wall of the maxillary sinus was seen on CT The result of the FNA was reactive hyperplasia of the lymph node. Since the lesion was easily accessible surgical exploration and complete extirpation was done. Pathohistological analysis indicated a low grade B-cell Non Hodgkin lymphoma. PCR showed policlonality of B cells discarding the diagnosis of lymphoma. Pathohistological review showed diffuse intramuscular, perineural and perivascular infiltration with small lymphocytes without formation of germinative centers. Imunohistochemistry was positive for CD20 and CD3. Taking into account all features the diagnosis of IPT was established. Diagnosis of IPT is a diagnosis by exclusion, combining clinical, radiological and pathohistological characteristics. Lack of clear histologic criteria makes differential diagnosis extremely difficult. Our case is unique regarding localisation of head & neck IPT no case presenting on the face in infraorbital region has been described in the literature. Although IPT is very rare in general and especially on the face, one should be aware of it when considering differential diagnosis of facial swelling.

Sulfur mustard-induced poikiloderma: a case report.

Sulfur mustard (SM) is a potent chemical warfare agent that was widely used during the First World War and the Iran-Iraq conflict. This vesicant agent causes several acute and chronic effects on the skin, eye, and respiratory system. We report the case of a 41-year-old man who was injured with SM in Iraq chemical attack in 1988. After exposure, he developed severe skin blisters on his upper trunk, dorsum of hands, and genitalia. Based on several clinical observations, such as atrophy, pigmentation, and vascular changes on genitalia with relevant findings in histopathological studies, persistent pigmentation, and damaged skin appendix in hand lesions, a diagnosis of "SM-induced poikiloderma" was postulated. The absence of any complication on the palmar aspect of hands is another remarkable finding in presented case, which suggests a plausible role of the palms as a vector for transporting SM to other sites of the skin.

Efficacy of home treatment of patients with mental disorders - a research review.

Purpose: The aim of this study is to review research on the efficacy of home treatment for mental disorders compared to other forms of community-based treatment. The first section describes studies comparing treatment as usual with CMHT (Community Mental Health Team), the second section compares CMHT with more intensive forms of community-based care, such as CM (Case Management) and ACT (Assertive Community Treatment, and the third section focuses on interventions that are alternatives to hospitalization, described as CRT or MCHT (Crisis Resolution Team or Mobile Crisis Home Treatment). Views: The community-based model of psychiatric health care is nowadays recognized as the best systemic solution to improve its organization and functioning. In comprehensive care in the community, home treatment plays an important role. Treatment teams most often take the form of a general Community Mental Health Team - CMHT, which, like community mental health services in Poland, provides a wide range of interventions. There are several forms of treatment within CMHTs: ACT, CM, CRT and MHCT. Comment: Home treatment is more effective compared to standard inpatient and post-hospital care. Care under a Community Mental Health Team reduces the number and duration of hospitalizations and is characterized by higher treatment satisfaction. For patients with psychotic disorders, more intensive forms of community-based care - such as ACT, CM, and CRT - are particularly valuable and effective.