Cutaneous lesions in a solid organ transplant recipient: A diagnostic dilemma.

We present the case of a 66-year-old female with a history of renal transplant in 1999 with new onset fevers and diffuse skin ulcerations. In this article, we present the diagnostic studies, differential diagnosis, and treatment decisions for the case.

Plant-based dietary patterns are associated with lower body weight, BMI and waist circumference in older Australian women.

OBJECTIVE: To investigate the association between plant-based diets (PBD) and overweight/obesity compared to regular meat eaters in older women. DESIGN: Cross-sectional analysis. SETTING: 1946-1951 birth cohort of the Australian Longitudinal Study on Women's Health (ALSWH). PBD were categorised as vegan, lacto-ovo vegetarian, pesco-vegetarian, semi-vegetarian and regular meat eaters. Outcomes included body weight (BW), BMI and waist circumference (WC). PARTICIPANTS: Women who completed Survey 7 (n 9102) with complete FFQ data. RESULTS: Compared to regular meat eaters, BW, BMI and WC were significantly lower in pesco-vegetarians (-10·2 kg (95 % CI -5·1, -15·2); -3·8 kg/m2 (95 % CI -2·0, -5·6); -8·4 cm (95 % CI -3·9, -12·9)) and BW and BMI lower in lacto-ovo vegetarians (-7·4 kg (95 % CI -1·2, -13·6); -2·9 kg/m2 (95 % CI -0·6, -5·1)). In regular meat eaters, individuals consuming meat daily or multiple times/d had significantly higher BW, BMI and WC compared to those consuming meat >2 times/week but 1 but ≤2 times/week (6·8 kg (95 % CI 1·8, 11·8); 2·1 kg/m2 (95 % CI 0·3, 4·0) and 6·0 cm (95 % CI 1·7, 10·4)). This association was dose-dependent such that for every increase in category of weekly meat intake (i.e. >1 time/week but ≤2 times/week; >2 times/week but less than daily, and daily or multiple times/d), an associated 2·6 kg (95 % CI 1·8, 3·4) increase in BW, 0·9 kg/m2 (95 % CI 0·6, 1·2) increase in BMI and 2·3 cm (95 % CI 1·6, 3·0) increase in WC was reported. CONCLUSIONS: BW, BMI and WC are lower in women following PBD and positively associated with increasing meat consumption. Results were robust to adjustment for confounders including physical activity levels, smoking status, habitual alcohol intake, use of supplements, and hormone replacement therapy.

Cutaneous cytomegalovirus - A case of disseminated cytomegalovirus presenting with extensive ulcerative skin lesions in a renal transplant recipient.

Cytomegalovirus (CMV) reactivation is common in organ transplant recipients and can lead to significant morbidity and mortality. Cutaneous CMV findings are rarely reported in the literature and diagnosis can be delayed if not clinically recognized. We describe a case of a female patient 20 years post renal transplant who presented with extensive ulcerative skin lesions and diarrhea. She rapidly deteriorated and died on day 5 of hospitalization. Autopsy noted extensive CMV involvement of skin and gastrointestinal (GI) tract by CMV-specific immunohistochemistry. These findings, along with high-grade CMV viremia, led to the final postmortem diagnosis of disseminated CMV infection. This case focuses on the cutaneous findings of disseminated CMV as recognition of CMV skin lesions can lead to earlier initiation of appropriate therapy in transplant recipients.

Characteristics and Outcomes of Coronavirus Disease Patients under Nonsurge Conditions, Northern California, USA, March-April 2020.

Limited data are available on the clinical presentation and outcomes of coronavirus disease (COVID-19) patients in the United States hospitalized under normal-caseload or nonsurge conditions. We retrospectively studied 72 consecutive adult patients hospitalized with COVID-19 in 2 hospitals in the San Francisco Bay area, California, USA, during March 13-April 11, 2020. The death rate for all hospitalized COVID-19 patients was 8.3%, and median length of hospitalization was 7.5 days. Of the 21 (29% of total) intensive care unit patients, 3 (14.3% died); median length of intensive care unit stay was 12 days. Of the 72 patients, 43 (59.7%) had underlying cardiovascular disease and 19 (26.4%) had underlying pulmonary disease. In this study, death rates were lower than those reported from regions of the United States experiencing a high volume of COVID-19 patients.

Viral breakthrough is associated with resistance using direct acting agents in patients treated for chronic hepatitis C infection.

BACKGROUND: Despite improved virologic response with the addition of direct acting agents to peginterferon and ribavirin treatment in chronic hepatitis C virus (HCV) genotype 1 infection, a subset of patients experience viral breakthrough while on therapy. Defining viral breakthrough and patient characteristics is important for ongoing and future HCV treatment. METHODS: Thirty-four patients treated with telaprevir between June 2011 and July 2012 were retrospectively evaluated for presence of viral breakthrough. Baseline patient characteristics, time to viral breakthrough, and HCV resistance patterns were determined. RESULTS: Viral breakthrough was seen in 26.5% of patients treated. Eight of 9 patients experienced breakthrough in the peginterferon and ribavirin-only phase of treatment with mean (±SD) time to breakthrough of 21.3 (±6.4) weeks. Viral breakthrough was more frequently seen in patients with genotype 1a, advanced liver fibrosis, and prior null treatment response. A majority of patients had presence of resistant mutations upon testing. CONCLUSIONS: A significant proportion of patients experience viral breakthrough after completion of the direct acting agent portion of triple therapy. More frequent virologic assessments during the peginterferon and ribavirin treatment phase may be necessary to reduce cost and adverse effects of treatment.

Cardiovascular Disease Risk in Individuals Following Plant-Based Dietary Patterns Compared to Regular Meat-Eaters.

Plant-based diets (PBDs) have been associated with a lower risk of cardiovascular disease (CVD). The aim was to investigate the predicted 5-year and 10-year risk of developing CVD in individuals following PBDs compared to regular meat-eating diets. This cross-sectional study included n = 240 middle-aged adults habitually consuming dietary patterns for ≥6 months: vegan, lacto-ovo vegetarian (LOV), pesco-vegetarian (PV), semi-vegetarian (SV) or regular meat-eater (RME) (n = 48 per group). Predicted 5-year and 10-year CVD risks were quantified using the Framingham Risk Equation and the Australian Absolute CVD risk calculator, respectively. Multivariable regression analysis was used to adjust for age, sex, smoking status, physical activity, alcohol use and BMI. Over three-quarters of the participants were women, mean age of 53.8 yrs. After adjustments for potential confounders, there was no difference in the predicted risk of CVD between regular-meat diets and PBDs, although crude analyses revealed that vegans had a lower 5-year and 10-year predicted risk of CVD compared to RMEs. SVs, PVs and LOVs had lower CVD risk scores, however, not significantly. Vegans had a favourable cardiometabolic risk profile including significantly lower serum lipid levels, fasting blood glucose and dietary fats and higher dietary fibre intake compared to RMEs. This was the first study to purposefully sample Australians habitually following PBDs. We found that PBDs do not independently influence the predicted risk of CVD, although PBDs tended to have lower risk and vegans had significantly lower cardiometabolic risk factors for CVD.

Bone mineral density and body composition in Australians following plant-based diets vs. regular meat diets.

Background and aims: Bone mineral density (BMD) and body composition play an important role in maintaining metabolic health and physical functioning. Plant-based diets (PBDs) are known to be lower in protein and calcium, which can impact BMD and body composition. This study aimed to investigate the relationship between various PBDs compared to regular meat diet and whole-body BMD, body composition, and weight status. Methods: A cross-sectional study was conducted with adults (n = 240) aged 30-75 years, who habitually followed dietary patterns: vegan, lacto-vegetarian, pesco-vegetarian, semi-vegetarian, or regular meat eater (48 per group). Parameters were measured using dual-energy x-ray absorptiometry (DXA), and multivariable regression analyses were used to adjust for lifestyle confounders, socioeconomic factors, and BMI. Results: After adjustments, whole-body BMD and body composition were not significantly different between those following PBDs and regular meat diets, except for lacto-ovo vegetarians, who had significantly lower lean mass by -1.46 kg (CI: -2.78, -0.13). Moreover, lacto-ovo vegetarians had a significantly lower T-score by -0.41 SD (CI: -0.81, -0.01) compared to regular meat eaters. Waist circumference was significantly lower in individuals adhering to a PBD compared to a regular meat diet: vegans by -4.67 cm (CI: -8.10, -1.24), lacto-ovo vegetarians by -3.92 cm (CI: -6.60, -1.23), pesco-vegetarians by -3.24 cm (CI: -6.09, -0.39), and semi-vegetarians by -5.18 cm (CI: -7.79, -2.57). There were no significant differences in lean mass (%), fat mass (% and total), android/gynoid measures, body weight, or BMI across dietary patterns. All dietary patterns met the recommended dietary intake for calcium and protein, and 25-hydroxy-vitamin D status was comparable across groups. Conclusions: This cross-sectional study found that adhering to a PBD characterized by varying degrees of dairy and meat restriction is not associated with meaningful changes in BMD or body composition, provided that the dietary patterns are planned appropriately with adequate levels of calcium and protein.

Racial/ethnic differences in treatment efficacy and safety for moderate-to-severe plaque psoriasis: a systematic review.

Biologic medications have revolutionized treatment of psoriasis; however, there remains uncertainty in which medications should be used to maximize efficacy based on race/ethnicity. The purpose was to determine if efficacy of biological medications differs based on race/ethnicity. A systematic review identified all clinical trials focused on biologic treatment outcomes from inception of database until March 5th, 2021. Included studies provided data on racial/ethnic differences in biologic skin clearance efficacy using the Psoriasis Area and Severity Index (PASI) and "clear/almost clear" scores. There were 1220 studies identified, and 24 included in the review. The races/ethnicities included were Asian (n = 2740), White (n = 9745), Black (n = 138), and Latino (n = 728). Ixekizumab provided the highest "clear/almost clear" score (90.7%, 89.4%) and PASI 75 (98.8%, 96.6%) for Asian and Latino patients, respectively. Guselkumab had the highest "clear/almost clear" score for White (86.8%) patients, while Black patients had highest "clear/almost clear" (75.0%) and PASI 75 (91.7%) scores to brodalumab. Limitations included lack of studies reporting outcome data based on race/ethnicity and lack of patients of color within psoriasis clinical trials. For treatment of plaque psoriasis, there is evidence of differences in efficacy of biologics improving clinical disease severity between different races or ethnicities.

Plant-Based Dietary Patterns and Cardiovascular Disease Risk in Australians: Protocol for a Cross-Sectional Study.

Plant-based diets (PBDs) emphasise higher intakes of plant foods and lower intakes of animal foods, and they have been associated with reduced cardiovascular morbidity/mortality and lower cardiovascular disease (CVD) risk factors. Evidence is limited regarding the dietary profile, diet quality, and nutritional adequacy of PBDs, including their impact on CVD risk compared with traditional meat-eating diets in Australians. The PBD Study (PBDS) is a cross-sectional study that will recruit 240 adults from the Hunter region (NSW) without known CVD who are habitually consuming vegan (no animal flesh/animal products), lacto-ovo vegetarian (dairy and/or eggs only), pesco-vegetarian (fish/seafood only), or semi-vegetarian (minimal animal flesh) diets or are a regular meat-eater. To investigate dietary profile, diet quality, nutritional adequacy, and CVD risk, questionnaires (medical history, demographics, and physical activity), blood samples (biomarkers), physical measures (anthropometry, blood pressure, body composition, and bone density), and dietary intake (food frequency questionnaire and diet history) will be collected. One-way ANOVA and Kruskal-Wallis tests will compare the CVD risk and other quantitative measures, and Chi-square or Fisher's Exact tests will be used for qualitative data. Directed acyclic graphs will determine the confounding variables, and linear regression and mediation analyses will account for the confounders and estimate the effect of dietary patterns on CVD risk. p-values will be adjusted using the Benjamini-Hochberg method to control the False Discovery Rate to 5%.

Dietary Assessment and Metabolomic Methodologies in Human Feeding Studies: A Scoping Review.

Dietary metabolomics is a relatively objective approach to identifying new biomarkers of dietary intake and for use alongside traditional methods. However, methods used across dietary feeding studies vary, thus making it challenging to compare results. The objective of this study was to synthesize methodological components of controlled human feeding studies designed to quantify the diet-related metabolome in biospecimens, including plasma, serum, and urine after dietary interventions. Six electronic databases were searched. Included studies were as follows: 1) conducted in healthy adults; 2) intervention studies; 3) feeding studies focusing on dietary patterns; and 4) measured the dietary metabolome. From 12,425 texts, 50 met all inclusion criteria. Interventions were primarily crossover (n = 25) and parallel randomized controlled trials (n = 22), with between 8 and 395 participants. Seventeen different dietary patterns were tested, with the most common being the "High versus Low-Glycemic Index/Load" pattern (n = 11) and "Typical Country Intake" (n = 11); with 32 providing all or the majority (90%) of food, 16 providing some food, and 2 providing no food. Metabolites were identified in urine (n = 31) and plasma/serum (n = 30). Metabolites were quantified using liquid chromatography, mass spectroscopy (n = 31) and used untargeted metabolomics (n = 37). There was extensive variability in the methods used in controlled human feeding studies examining the metabolome, including dietary patterns tested, biospecimen sample collection, and metabolomic analysis techniques. To improve the comparability and reproducibility of controlled human feeding studies examining the metabolome, it is important to provide detailed information about the dietary interventions being tested, including information about included or restricted foods, food groups, and meal plans provided. Strategies to control for individual variability, such as a crossover study design, statistical adjustment methods, dietary-controlled run-in periods, or providing standardized meals or test foods throughout the study should also be considered. The protocol for this review has been registered at Open Science Framework (https://doi.org/10.17605/OSF.IO/DAHGS).

Dietary metabolome profiles of a Healthy Australian Diet and a Typical Australian Diet: protocol for a randomised cross-over feeding study in Australian adults.

INTRODUCTION: Traditional dietary assessment methods such as 24-hour recalls and food frequency questionnaires rely on self-reported data and are prone to error, bias and inaccuracy. Identification of dietary metabolites associated with different dietary patterns can provide objective markers of whole diet patterns that account for metabolism and individual responses to dietary interventions. Additionally, few studies have investigated country-specific healthy and unhealthy dietary patterns using metabolomics. Therefore, the current study aims to identify urinary and plasma metabolites that characterise a 'healthy' (aligned with current national dietary guidelines) and an 'unhealthy' dietary pattern (Typical Australian Diet) in Australian adults. METHODS AND ANALYSIS: The Diet Quality Feeding Study (DQFS) is an 8-week cross-over feeding study that will recruit 40 healthy adults from the Hunter region (NSW, Australia). Data collected includes biospecimens (whole blood, urine, stool) for quantification of dietary metabolite biomarkers; questionnaires (medical history/demographic, physical activity, quality of life); physical measures (anthropometry, body composition, waist circumference, blood pressure, arterial pressure); skin carotenoids and dietary intake (24-hour recalls, food frequency questionnaire). Participants will attend the research facility every 2 weeks (end of the run-in, each diet intervention and washout period) for collection of physical measures. All food will be provided to participants for each dietary intervention period, and participants will return to their usual diet during the run-in and washout periods. Targeted and untargeted metabolomics using liquid chromatography-mass spectrometry and/or proton nuclear magnetic resonance (1H-NMR) spectroscopy will be used to identify metabolites in biospecimens associated with dietary intake. ETHICS AND DISSEMINATION: This study is approved by the Hunter New England Human Research Ethics Committee (HNEHREC; 2022/ETH01649) and the University of Newcastle's Human Research Ethics Committee (HREC; H-2022-0330). Findings will be disseminated to study participants, funding bodies supporting the DQFS, peer-review publications and presented at scientific conferences within the field of research. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ACTRN12622001321730).

Red Blood Cell Membrane Fatty Acid Composition, Dietary Fatty Acid Intake and Diet Quality as Predictors of Inflammation in a Group of Australian Adults.

Evidence suggests that diet can play a role in modulating systemic inflammation. This study aims to examine the relationship between fatty acids (FAs) (self-reported dietary intake and red blood cell (RBC) membrane fatty acid concentrations), three diet quality scores, and the plasma concentrations of inflammatory markers (interleukin-6, IL-6; tumour necrosis factor alpha, TNF-α; and C-reactive protein, CRP) in a group of Australian adults (n = 92). Data were collected on their demographic characteristics, health status, supplement intake, dietary intake, RBC-FAs and plasma inflammatory markers over a nine-month period. Mixed-effects models were used to determine the relationship between RBC-FAs, dietary intake of FAs, diet quality scores and inflammatory markers to determine which variable most strongly predicted systemic inflammation. A significant association was identified between dietary saturated fat intake and TNF-α (ß = 0.01, p < 0.05). An association was also identified between RBC membrane saturated fatty acids (SFA) and CRP (ß = 0.55, p < 0.05). Inverse associations were identified between RBC membrane monounsaturated fatty acids (MUFAs) (ß = -0.88, p < 0.01), dietary polyunsaturated fatty acids (PUFAs) (ß = -0.21, p < 0.05) and CRP, and the Australian Eating Survey Modified Mediterranean Diet (AES-MED) score and IL-6 (ß = -0.21, p < 0.05). In summary, using both objective and subjective measures of fat intake and diet quality, our study has confirmed a positive association between saturated fat and inflammation, while inverse associations were observed between MUFAs, PUFAs, the Mediterranean diet, and inflammation. Our results provide further evidence that manipulating diet quality, in particular fatty acid intake, may be useful for reducing chronic systemic inflammation.

Use of a severe acute respiratory coronavirus virus 2 (SARS-CoV-2) strand-specific assay to evaluate for prolonged viral replication >20 days from illness onset.

Severe acute respiratory coronavirus virus 2 (SARS-CoV-2) real-time reverse-transcription polymerase chain reaction (rRT-PCR) strand-specific assay can be used to identify active SARS-CoV-2 viral replication. We describe the characteristics of 337 hospitalized patients with at least 1 minus-strand SARS-CoV-2 assay performed >20 days after illness onset. This test is a novel tool to identify high-risk hospitalized patients with prolonged SARS-CoV-2 replication.

Antioxidant Effects of a Polyphenol-Rich Dietary Supplement Incorporating Pinus massoniana Bark Extract in Healthy Older Adults: A Two-Arm, Parallel Group, Randomized Placebo-Controlled Trial.

Oxidative stress is a key physiological phenomenon underpinning the ageing process and plays a major developmental role in age-associated chronic diseases. This study investigated the antioxidant effects of a polyphenol-rich dietary supplement containing Pinus massoniana bark extract (PMBE) in healthy older adults. In a double-blinded, placebo-controlled clinical trial, participants were randomised (in a 1:1 ratio) to receive a 50 mL/day dietary supplement containing placebo (0 mg PMBE) or PMBE (1322 mg PMBE) for 12 weeks. The primary outcome was fasting plasma malondialdehyde (MDA) concentrations and secondary outcomes were plasma inflammatory markers. MDA concentrations significantly reduced following PMBE for 6 weeks (−1.19 nmol/mL, 95%CI −1.62, −0.75, p < 0.001) and 12 weeks (−1.35 nmol/mL, 95%CI −1.74, −0.96, p < 0.001) compared to baseline. MDA did not significantly change after the placebo. MDA levels at 6 and 12 weeks were significantly lower following PMBE compared to placebo (p < 0.001). At 12 weeks in the PMBE group, fibrinogen concentrations significantly reduced (−0.25 g/L, 95%CI −0.39, −0.11; p < 0.0001) and interleukin-6 significantly increased compared to placebo (0.30 pg/mL, 95%CI 0.02, 0.59; p < 0.05). PMBE in a polyphenol-rich dietary supplement reduced oxidative stress in healthy older adults. Further studies are warranted to investigate the antioxidant capacity of PMBE in conditions with heightened oxidative stress, such as osteoarthritis, hypertension, type 2 diabetes, or other lifestyle related diseases.

Plant-Based Dietary Patterns versus Meat Consumption and Prevalence of Impaired Glucose Intolerance and Diabetes Mellitus: A Cross-Sectional Study in Australian Women.

This study aimed to compare the prevalence of impaired glucose tolerance (IGT) and diabetes mellitus (DM) among Australian women following plant-based diets (PBD) compared to regular meat eaters. A cross sectional analysis of the mid-aged cohort (1946−1951) of the Australian Longitudinal Study on Women's Health was conducted on completers of Survey 7 in 2013 with complete FFQ data available (n = 9102). Dietary patterns were categorized as PBD (vegan, lacto-ovo vegetarian, pesco-vegetarian, semi-vegetarian) and regular meat eaters. Meat eaters were further categorized into high and low consumption and outcomes included self-reported prevalence of IGT and DM. Participants were identified as regular meat eaters (n = 8937) and PBD (n = 175). Prevalence of IGT was lower in PBD (0−1.2%) compared to regular meat eaters (9.1%). Consolidation of PBD to a single group (vegetarians) indicated a lower prevalence of DM in vegetarians compared to regular meat eaters (3.9% vs. 9.1%). Women consuming meat daily/multiple times per day had significantly higher odds of IGT (OR 1.5, 95%CI 1.1 to 2.1, p = 0.02). Individuals consuming processed meat daily/multiple times per day had significantly higher odds of DM compared to those consuming less than daily (Odds ratio (OR) 1.7, 95% confidence interval (CI) 1.3 to 2.3, p < 0.0001). After adjustment for covariates, statistical significance was lost largely due to the addition of BMI to the model. Prevalence of IGT and DM were lower in women following PBD and higher in high consumers of meat and processed meat. The relationship between meat consumption and IGT/diabetes status appears to be mediated, at least in part, by an increase in body mass index (BMI). Future studies are warranted to investigate the mechanisms and other lifestyle factors underpinning the association between high meat consumption and increased risk of IGT and DM.

Effect of a polyphenol-rich dietary supplement containing Pinus massoniana bark extract on blood pressure in healthy adults: A parallel, randomized placebo-controlled trial.

OBJECTIVES: High blood pressure (BP) is a major risk factor for cardiovascular disease and prevalence rates continue to rise with ageing populations. Polypharmacy remains a burden among the ageing, thus alternative effective strategies are warranted. This study investigated the effects of a polyphenols rich dietary supplement containing Pinus massoniana bark extract (PMBE) for modulating BP in healthy Australian adults. DESIGN: This study is a secondary analysis of data from a double-blinded, placebo-controlled clinical trial. METHODS: Sixty-two healthy adults aged 55-75 years were randomized to receive 50 mL dietary supplement containing placebo (0 mg PMBE) or PMBE (1322 mg PMBE) daily for 12 weeks. Seated systolic BP (SBP) and diastolic (DBP) were measured at baseline, 6 weeks and 12 weeks. Effects of PMBE on modulating BP was also explored in this study stratified for SBP status (optimal v high) as well as by SBP medication status. Mixed effect regression modelling was employed involving fixed categorical effects for elapsed time, treatment assignment and their interaction as well as random subject-level intercept to account for within-subject correlations resulting from repeated measurements. Significant models were further examined by addition of covariates and power calculations were performed since this study was a secondary analysis. RESULTS: SBP significantly reduced (-3.29 mmHg, p = 0.028) after PMBE at 12 weeks compared to baseline. SBP in individuals with normal-high SBP (>120 mmHg) in the PMBE group reduced by - 6.46 mmHg (p = 0.001) at 12 weeks compared to baseline. No significant changes were reported for individuals with optimal (≤120 mmHg) SBP nor did DBP significantly change in either study groups. In individuals with non-medicated normal-high SBP, SBP significantly reduced by - 7.49 mmHg (p = 0.001) and DBP by - 3.06 mmHg (p = 0.011) at 12 weeks compared to baseline after PMBE. Cross-group comparisons were not statistically different. CONCLUSIONS: A polyphenol-rich dietary supplement derived from PMBE led to a clinically and statistically significant reduction in SBP in adults. Future studies to investigate the effects of PMBE-polyphenol supplementation on BP are warranted to confirm and explore optimal dose and impact on hypertension.

Postponed depth electrode placement due to seborrheic dermatitis of the scalp: illustrative case.

BACKGROUND: Seborrheic dermatitis is a common fungal infection of the scalp that may potentially affect depth electrode placement for intracranial seizure monitoring. No cases documenting the safety of proceeding with depth electrode placement in the setting of seborrheic dermatitis have been reported. OBSERVATIONS: A 19-year-old man with a history of drug-resistant epilepsy was taken to the operating room for placement of depth electrodes for long-term seizure monitoring. Annular patches of erythema with trailing scales were discovered after shaving the patient's head. Dermatology service was consulted, and surgery was cancelled because of the uncertainty of his diagnosis and possible intracranial spreading. He was diagnosed with severe seborrheic dermatitis and treated with topical ketoconazole. Surgery was rescheduled, and the patient received successful placement and removal of depth electrodes without any complications. LESSONS: Seborrheic dermatitis is a common skin infection that, in the authors' experience, is unlikely to lead to any intracranial spread after treatment. However, surgeons should use clinical judgment and engage dermatology colleagues regarding any uncertain skin lesions.

Association of Plasma Neurofilament Light Chain With Glycaemic Control and Insulin Resistance in Middle-Aged Adults.

Aims: This study aimed to determine the association of plasma neurofilament light (NfL), a marker of neurodegeneration, with diabetes status and glycaemic parameters in people with normal glycaemia (NG), pre-diabetes (PD) and type 2 diabetes (T2D). Methods: Clinical and descriptive data for the diagnostic groups, NG (n=30), PD (n=48) and T2D (n=29), aged between 40 and 75 years were included in this cross-sectional analysis. Plasma NfL levels were analyzed using the ultra-sensitive single-molecule array (Simoa) platform. Results: A positive correlation was evident between plasma NfL and fasting glucose (r = 0.2824; p = 0.0032). Plasma NfL levels were not correlated with fasting insulin and insulin resistance. Plasma Nfl levels were significantly different across the diabetes groups (T2D >PD >NG, p=0.0046). Post-hoc analysis indicated significantly higher plasma NfL levels in the T2D [12.4 (5.21) pg/mL] group than in the PD [10.2 (4.13) pg/mL] and NG [8.37 (5.65) pg/mL] groups. The relationship between diabetes status and NfL remained significant after adjusting for age, sex, BMI, HOMA-IR and physical activity (adjusted r2 = 0.271, p = 0.035). Conclusions: These results show biomarker evidence of neurodegeneration in adults at risk or with T2D. Larger sample size and longitudinal analysis are required to better understand the application of NfL in people with risk and overt T2D.

Terbinafine used safely in autoimmune hepatitis for treatment of tinea corporis.

Terbinafine is often considered contraindicated in those with liver disease, as one of the known side effects is hepatotoxicity. We report the first case documenting the safe use of oral terbinafine in a 77-year-old woman with stable autoimmune hepatitis presenting with extensive tinea corporis. Precautions were carried out to minimise the risk of worsening hepatotoxicity, including consultation with the patient's hepatologist, limiting terbinafine exposure to less than 6 weeks, monitoring of liver function tests, and patient education. The patient's fungal infection cleared without any signs or symptoms of worsening liver disease. The rash had not recurred 6 months after treatment. When terbinafine must be used in a patient with pre-existing liver disease, we recommend considering a short course of oral terbinafine after consultation with their hepatologist, obtaining baseline liver function tests with consideration of further monitoring during treatment course, and patient education on the signs and symptoms of liver injury.