Striae gravidarum treatment: evaluating non-ablating fractional laser (NAFL) efficacy and safety.

BACKGROUND: Striae gravidarum (SG) is a common pregnancy-related dermatologic problem, for which finding an effective treatment remains a challenge. AIM: To evaluate the safety and efficacy of 1540 nm non-ablative fractional laser (Star lux 500) in the treatment of SG in Iranian women and peruse the relationship between clinical improvement rate and patient characteristics as well as clinical features of striae. METHOD: A prospective before-after study was conducted on 50 patients with SG who received three monthly sessions of 1540 nm non-ablative fractional laser and were followed for 2 months after the last treatment session. Clinical changes were measured using both provider-rated outcome through before/after pictures represented by final clinical score (from 0 to 5) and patient-reported outcome (patient global assessment or PGA). RESULTS: Over the course of the study both final clinical score and PGA increased significantly from week 4 to week 20 (P value: <0.001 and 0.048, respectively). Only modest adverse effects including erythema, edema and hyperpigmentation were noted. CONCLUSION: In conclusion, patients with SG of different type (rubra/alba) or maturity may somehow benefit from treatment with NAFL experiencing minimal transient side effects.Therefore, NAFL may be considered a safe and partially effective treatment option for stretch mark of patients with SG.

Is skin autofluorescence a novel non-invasive marker in diabetes? A systematic review and meta-analysis of case-control studies.

Background: The advanced glycation end product (AGE) is produced from the nonenzymatic reaction between glucose and macromolecules by aging. Accumulation of AGE causes functional and structural changes in body proteins that lead to impairment of tissue protein functions. We aimed to validate AGE measurement by skin autofluorescence (SAF) in diabetes mellitus (DM) compared to the nondiabetes population. Materials and Methods: We searched the PubMed, Cochrane, and Scopus databases from their inception till September 18, 2022, for casecontrol studies measuring AGE by SAF. Nonhuman studies, as well as review articles, study proposals, editorials, case reports, or congress posters, were excluded. We used a random effects model to assess the standard mean difference (MD) of age, body mass index (BMI), HbA1c, and SAF between diabetes and nondiabetes individuals. Results: Higher SAF in DM patients indicated more accumulation of AGE compared with the nondiabetic population. Furthermore, HbA1c was considerably higher in DM patients. The MD of age, male gender, and BMI were significantly different between the DM individuals, compared with nondiabetic subjects, which can lead to altered SAF level and AGE production. There was a remarkable heterogeneity between diabetes and nondiabetes when measuring age, gender, and BMI, as well as HbA1c and SAF level. Conclusion: This study could not confirm the validity of SAF as a surrogate marker in diabetes patients. Interestingly, metabolic load and high BMI can increase SAF, considerably. Altogether, SAF could be helpful in the future as a marker for metabolic syndrome or diabetes.

Metabolic Syndrome and Its Components are Linked with Increased Risk of Non-Melanoma Skin Cancers in Iranian Subjects: A Case-Control Study.

The associations between components of metabolic syndrome (MetS), insulin resistance (IR), and several malignancies have been reported. However, the possible link between IR and dermal malignancies, including non-melanoma skin cancers (NMSCs), has not been investigated to date. In this study, we aimed to examine the possible association between components of MetS, IR, adhesion molecules, and NMSC for the first time. This was a case-control study comprising 73 confirmed cases of NMSC and 72 unrelated healthy controls. Anthropometric and biochemical assessments including fasting blood lipid profile, glucose and insulin assays were performed. To evaluate IR, HOMA-IR formula was used. Though fasting serum glucose showed no significant between-group difference, serum concentrations of insulin (p = 0.048) as well as HOMA-IR (p = 0.037) were both significantly higher in NMSC group than in controls. Logistic regression analysis revealed significant associations between waist circumference (OR: 1.04, 95% CI: 1.007-1.080, p = 0.018), percent of visceral fat (OR: 1.10, 95% CI: 1.024-1.190, p = 0.01), HOMA-IR (OR: 1.169, 95% CI: 1.004-1.360, p = 0.044), circulating VCAM-1 concentrations (OR: 1.005, 95% CI: 1.003-1.007, p < 0.001) and NMSC risk. Interestingly, the occurrence of MetS was significantly higher in subjects with NMSC than in healthy controls (p = 0.038). MetS and its components were associated with increased NMSC risk.

Tropospheric Ozone in Tehran, Iran, during the last 20 years.

Air pollution and its effects on human health and the environment are one of the main concerns in urban areas. This study focuses on the distribution and changes in the concentrations of ozone and its precursors (i.e., NO, NO2 and CO) in Tehran for the 20-year period from 2001 to 2020. The effects of precursors and meteorological conditions (temperature, wind speed, dew point, humidity and rainfall) on ozone were investigated using data from 22 stations of the Air Quality Control Company (AQCC) and meteorological stations. Regression models were applied to evaluate the dependence of ozone concentration on its precursors and meteorological parameters based on monthly average values. Finally, the monthly and annual levels of surface ozone and total column ozone were compared during the study period. The results show that the average ozone concentration in Tehran varied substantially between 2001 and 2008, and decreased after 2008 when stringent air quality control measures were implemented. The highest average concentration of ozone occurred in the southwest of Tehran. Although mobile and resident sources play an important role in the release of precursors, the results also indicate a significant effect of meteorological conditions on the changes in ozone concentration. This study is an effective step toward a better understanding of ozone changes in Tehran under the changing influence of precursors and meteorological conditions.

Changes in short-lived climate pollutants during the COVID-19 pandemic in Tehran, Iran.

This study investigates the changes of short-lived climate pollutants and other air pollutants during the COVID-19 pandemic in Tehran, Iran. Concentrations of air pollutants were obtained from 21 monitoring stations for the period from 5 January 2019 to 5 August 2019, representing normal conditions unaffected by COVID-19, and the period 5 January 2020 to 5 August 2020, i.e., during the COVID-19 crisis. We concentrated our analysis on three time windows (23 February 2020 to 15 March 2020, 18 March 2020 to 3 April 2020, and 5 April 2020 to 17 April 2020) during the lockdown when different sets of measures were taken to limit the spread of COVID-19. In comparison to the period not affected by COVID-19 measures, mean concentrations of pollutants were increased during the first lockdown period; when the number of COVID-19 patients increased sharply compared to the other periods, the mean surface concentrations of NO2, SO2, and CO were decreased and concentrations of other pollutants (i.e., O3, PM10, and PM2.5) were increased during the second lockdown period compared to the corresponding period in 2019. In the third period, the mean concentrations were decreased compared to the corresponding period in 2019. For the full period, decreases in mean concentrations of O3, NO2, SO2, CO, and PM10 and increases in PM2.5 were observed during the COVID-19 crisis, compared to 2019. Overall, the strongest reductions, 12% and 6%, respectively, were observed for CO and NO2, pointing to reduced emissions from traffic as a result of lockdown measures. The concentrations of other pollutants changed little, suggesting that the lockdown measures did not result in strong changes in the emissions from stationary sources.

Efficacy of a Natural Topical Skin Ointment for Managing Split-Thickness Skin Graft Donor Sites: A Pilot Double-blind Randomized Controlled Trial.

OBJECTIVE: To evaluate the safety and efficacy of a new topical skin ointment with natural ingredients (aloe vera, honey, and peppermint) for dressing skin graft donor sites. DESIGN: A double-blind, placebo-controlled, randomized clinical trial. PATIENTS AND INTERVENTION: Researchers enrolled patients who were referred for split-thickness skin graft after burns or surgical wounds on the scalp or face area. For each patient, a thin layer of skin (depth, 0.04 mm; approximate size, less than 15 × 7 cm) was harvested from the thigh by a plastic surgeon with an electric or manual dermatome. The donor sites were divided and randomized to receive either natural ointment or petroleum jelly as a topical agent to dressing. Topical agents were applied on donor site wounds on days 0, 4, 7, and 14. MAIN OUTCOME MEASURES: Wound size, pain, erythema, pruritus, patient discomfort, complications, and physician satisfaction were evaluated at each visit. MAIN RESULTS: Among 28 patients, there was no significant difference between the two treatment agents regarding the rate of wound healing (P = .415), pain (P = .081), pruritus (P = .527), and patient discomfort (P = .616). The ointment was superior to petroleum jelly in reducing wound erythema (P = .001) and was associated with significantly better treatment satisfaction (P < .001). CONCLUSIONS: The natural topical ointment investigated in this study may be an acceptable alternative to petroleum jelly in caring for split-thickness donor skin graft donor site wounds to effectively promote wound healing, prevent infection and scarring, reduce pain, and comfort the patient.

Basal cell carcinoma associated with erythema ab igne.

Erythema ab igne is a skin condition mainly caused by heat exposure. Erythema ab igne usually follows a favorable prognosis. However, it may increase the risk of developing cutaneous malignancy in the involved skin. Being familiar with the type of cutaneous malignancies that may arise in the site of erythema ab igne is considerably important. To our knowledge, this letter presents the first case that shows the association between erythema ab igne and basal cell carcinoma.

Iranian guideline for rituximab therapy in pemphigus patients.

Pemphigus vulgaris (PV) is an autoimmune blistering disease affecting the skin and/or mucosa. Rituximab (RTX) has been approved recently by US FDA as an effective and safe treatment of PV. The high incidence of PV in Iran encouraged our team to prepare a consensus guideline for RTX administration based on literature review and a decade experience of an expert panel. RTX is recommended for the treatment of new cases of PV as well as patients not responding to conventional therapy. Contraindications include history of anaphylaxis or IgE-mediated hypersensitivity to murine proteins of RTX, severe active infections, pregnancy, breastfeeding, severe heart failure, and arrhythmia. Prophylactic antiviral therapy is recommended in patients at risk of reactivation of HBV and isoniazid for those at risk of reactivation of tuberculosis. Concomitant use of systemic corticosteroids is recommended as a rule. Except for methotrexate, the combination with other immunosuppressive drugs is discouraged. Intravenous immunoglobulin is recommended for those at risk of infections or with extensive disease. The recommended dosage of RTX for the first cycle is 2 g either 500 mg weekly or 1 g biweekly. There is no general consensus whether the next doses of RTX be administered upon relapse or as maintenance therapy. We strongly recommend RTX sooner in the course of pemphigus.

Comparison of biophysical, biomechanical and ultrasonographic properties of skin in chronic dermatitis, psoriasis and lichen planus.

Background: Skin biometrology is a useful method for evaluation of inflammatory skin disorders such as dermatitis, psoriasis, and lichen planus. The current study tries to compare the biophysical features of skin in dermatitis, psoriasis, and lichen planus. Methods: By a convenient sampling method, 22 mild to moderate chronic dermatitis, 26 psoriasis, and 21 lichen planus patients were recruited in the study. Stratum corneum (S.C.) hydration, Transepidermal water loss (TEWL), pH, erythema, melanin, sebum, friction, elasticity parameters (R0, R2, and R5), skin temperature, skin thickness, and echo-density of epidermis and dermis were measured on the lesional (selected active lesion), uninvolved perilesional, and uninvolved symmetrical skin. The average of perilesional and symmetrical uninvolved parameters was used as control, while the percentage change of each parameter [(lesion - control / control) ×100] was calculated, and compared among three diseases by ANOVA test using SPSS software version 18. The significance level was set at α=0.05. Results: Comparison of percentage changes showed that the changes in TEWL, friction index, sebum content, R2 (gross elasticity), R5 (net elasticity), skin temperature, dermal thickness, and epidermal density are not significantly different among three skin diseases. But there were significant differences in three diseases considering the decrease in S.C. hydration (p<0.001), R0 (opposed to firmness) (p<0.001), and dermal density (p<0.001) compared to control skin. Moreover, the increase in skin pH (p<0.001), melanin content (p=0.048), erythema (p=0.023), and epidermal thickness (p <0.001) significantly differed among these diseases. Conclusion: Dermatitis, psoriasis and lichen planus lesions had specific biophysical changes. It may be helpful in their differential diagnosis.

Tranexamic acid in treatment of melasma: A comprehensive review of clinical studies.

Melasma is a human melanogenesis dysfunction that results in localized, chronic acquired hyperpigmentation of the skin. It has a significant impact on appearance, causing psychosocial and emotional distress, and reducing the quality of life of the affected patients. Tranexamic acid (TA) is a plasmin inhibitor used to prevent abnormal fibrinolysis to reduce blood loss and exerts its effect by reversibly blocking lysine binding sites on plasminogen molecules, thus inhibiting plasminogen activator (PA) from converting plasminogen to plasmin. As plasminogen also exists in human epidermal basal cells and cultured human keratinocyte are known to produce PA, there is basic rationale that TA will affect keratinocyte function and interaction. A thorough literature review indicates that while TA is used through various route of administration including oral, topical, and intradermal injection and as adjutant therapy with laser to treat melasma, its efficacy is not established adequately. Further studies are needed to clarify the role of TA in treatment of melasma.

Enhancing spatial resolution of satellite soil moisture data through stacking ensemble learning techniques.

Soil moisture (SM) is a critical variable influencing various environmental processes, but traditional microwave sensors often lack the spatial resolution needed for local-scale studies. This study develops a novel stacking ensemble learning framework to enhance the spatial resolution of satellite-derived SM data to 1 km in the Urmia basin, a region facing significant water scarcity. We integrated in-situ SM measurements (obtained using time-domain reflectometry [TDR]), Soil Moisture Active Passive (SMAP) and Advanced Microwave Scanning Radiometer 2 (AMSR2) SM products, Moderate Resolution Imaging Spectroradiometer (MODIS) land surface temperature and vegetation indices, precipitation records, and topography data. Ten base machine-learning models were evaluated using the Complex Proportional Assessment (COPRAS) method, and the top-performing models were selected as base learners for the stacking ensemble. The ensemble model, incorporating Random Forest, Gradient Boosting, and XGBoost, significantly improved SM estimation accuracy and resolution compared to individual models. The XGBoost and Gradient Boosting meta-models achieved the highest accuracy, with an unbiased root mean square error (ubRMSE) of 1.23% m3/m3 and a coefficient of determination (R2) of 0.97 during testing, demonstrating the exceptional predictive capabilities of our approach. SHapley Additive exPlanations (SHAP) analysis revealed the influence of each base model on the ensemble's predictions, highlighting the synergistic benefits of combining diverse models. This study establishes new benchmarks for soil moisture monitoring by showcasing the potential of ensemble learning to improve the spatial resolution and accuracy of satellite-derived SM data, providing crucial insights for environmental science and agricultural planning, particularly in water-stressed regions.

Spatiotemporal ecosystem services: Response to structural changes (A case study in Lahijan, Iran).

Structure and function are the inherent characteristics of each ecosystem providing various services such as clean air, extreme weather mitigation, and mental and physical well-being. The objective of this study is to develop a unified model combining Integrated Valuation of Ecosystem Services, ecological network (EN), and correlation analysis to investigate changes in ecosystem structure, function, and process. In this context, carbon sequestration, soil reduction, and flood risk mitigation were quantified from 2000 to 2020 and predicted for 2040 using the cellular automata and Markov chain (CA-Markov) model. Finally, correlation analysis was used to analyze the relationship over time between the land use (LU) classes and the components of the forest EN that provide and exchange desired ecosystem services (ESs). Thus, the changes in LU in the region in recent years led to significant reduction of ESs in the region as well as changes in the interaction between services. These changes, on the one hand, reduced the area of cores and increased isolated forest patches and, on the other hand, led to the horizontal expansion of cities and agricultural lands. If this trend continues, the decline in services provided by the ecosystem will persist into the future. Consequently, it can be said that structural changes in the ecosystem can lead to changes in the ESs. Integr Environ Assess Manag 2023;00:1-13. © 2023 SETAC.

Current Status and Future Forecast of Short-lived Climate-Forced Ozone in Tehran, Iran, derived from Ground-Based and Satellite Observations.

In this study, the distribution and alterations of ozone concentrations in Tehran, Iran, in 2021 were investigated. The impacts of precursors (i.e., CO, NO2, and NO) on ozone were examined using the data collected over 12 months (i.e., January 2021 to December 2021) from 21 stations of the Air Quality Control Company (AQCC). The results of monthly heat mapping of tropospheric ozone concentrations indicated the lowest value in December and the highest value in July. The lowest and highest seasonal concentrations were in winter and summer, respectively. Moreover, there was a negative correlation between ozone and its precursors. The Inverse Distance Weighting (IDW) method was then implemented to obtain air pollution zoning maps. Then, ozone concentration modeled by the IDW method was compared with the average monthly change of total column density of ozone derived from Sentinel-5 satellite data in the Google Earth Engine (GEE) cloud platform. A good agreement was discovered despite the harsh circumstances that both ground-based and satellite measurements were subjected to. The results obtained from both datasets showed that the west of the city of Tehran had the highest averaged O3 concentration. In this study, the status of the concentration of ozone precursors and tropospheric ozone in 2022 was also predicted. For this purpose, the Box-Jenkins Seasonal Autoregressive Integrated Moving Average (SARIMA) approach was implemented to predict the monthly air quality parameters. Overall, it was observed that the SARIMA approach was an efficient tool for forecasting air quality. Finally, the results showed that the trends of ozone obtained from terrestrial and satellite observations throughout 2021 were slightly different due to the contribution of the tropospheric ozone precursor concentration and meteorology conditions.

Anatomic evaluation of the normal variants of the arteries of face using color Doppler ultrasonography: Implications for facial aesthetic procedures.

BACKGROUND: Knowledge of normal facial vascular variations could prevent catastrophic complications of cosmetic procedures as well as providing a guide for surgical planning. Color Doppler ultrasound is a safe and noninvasive method for real time vascular evaluation. OBJECTIVE: The aim of this study was to evaluate the normal variations of the facial, angular, transverse facial, supratrochlear and supraorbital arteries in a sample of normal individuals. METHODS: Normal individuals referred for dermal filler injection to the tertiary dermatologic center, were selected. Patients who were smoker or had a history of facial filler injection, facial surgery, or trauma were excluded from the study. Facial artery at three levels as well as angular, supratrochlear, supraorbital, and transverse facial arteries were evaluated by an 18 MHz ultrasound linear probe regarding their distance from facial reference lines and landmarks, and also their depths in various regions of face. RESULTS: A total number of 43 individuals were evaluated in this study. Thirty-one (72.1%) were women. The number of absent facial artery was zero in level one, three (3.48%) in level two, and nine (10.46%) in level three. The angular artery was absent in 10 (11.62%) participants. The transverse facial artery was absent in 27 (31.39%) assessed individuals. Distance from reference lines at level 2 and 3 of facial artery and its depth at level 2 were significantly different between left and right side (p-values: <0.001, 0.01, and 0.03, respectively). No significant difference was seen between depth and distance of two sides for angular and transverse facial arteries. The comparison of the depths and distances from the reference lines of the assessed arteries between two sexes revealed only a significantly greater value of facial artery distance in level 1 in males (p-value: 0.001). BMI was also significantly correlated with the depth of facial artery in level 2 (Pearson correlation coefficient = 0.471, p-value = 0.002) and level 3 (Pearson correlation coefficient = 0.357, p-value = 0.03) and the distance of the facial artery in level 1 (Pearson correlation coefficient = 0.333, p-value = 0.029). CONCLUSIONS: Color Doppler ultrasound could be used to map the arteries of face to prevent vascular complications and safely guide cosmetic procedures.

Estimation of short-lived climate forced sulfur dioxide in Tehran, Iran, using machine learning analysis.

This paper presents a time-series analysis of SO2 air concentration and the effects of particulates (either PM2.5 and PM10) concentrations and meteorological conditions (relative humidity and wind speed) on SO2 trend in Tehran for the period from 2011 to 2020. The source data were obtained from 21 monitoring stations of Air Quality Control Company and meteorological stations in Tehran. To predict the status of future concentration of SO2, PM2.5 and PM10, a Box-Jenkins ARIMA approach was used to model the monthly time series. Considering the whole period of ten years, a somewhat downward trend was noted for SO2 air concentration, even though a slight rising trend was observed in 2020 year. Monthly sulfur dioxide concentrations showed the lowest value in June and the highest value in January. Seasonal concentrations were lowest in spring and highest in winter. Then, in the ArcGIS software, the IDW method was used to obtain air pollution zoning maps. As a result, the highest average concentration of SO2 occurred in the north and southwest of Tehran. In the last step, Relations between the SO2 concentration and particulate matters and relative humidity and wind speed were calculated statistically using the daily average data. We finally concluded that the combined effect of particulate matters and relative humidity with the increasing role of Sulfur dioxide overcomes the decreasing role of wind speed. This study can contribute to a better understanding of the SO2 air pollution in Tehran affected by meteorological conditions and the rapid urbanization and industrialization, followed by the possible combustion of fuel oil in power plants and health problems.

Effect of Laser-Assisted Hair Removal (LAHR) on the Quality of Life and Depression in Hirsute Females: A Single-Arm Clinical Trial.

Introduction: Hirsutism, mainly due to polycystic ovary syndrome (PCOS), causes stress, anxiety, and depression in females. Laser-assisted hair removal (LAHR) is currently accepted as a good treatment option for hirsutism. The goal of the current study was to ascertain how LAHR affected the degree of hirsutism, quality of life, and depression in hirsute females. Methods: A single-arm before/after clinical trial was designed and performed in the Razi hospital Laser Clinic over a 15-month period. All hirsute females visiting the Razi hospital laser clinic were enrolled and received three sessions of LAHR every 4-6 weeks if they were interested and signed an informed consent form. Before the commencement of LAHR and six to eight weeks after the last session, the Ferriman-Gallwey score (hirsutism severity), Beck score (depression index) and DLQI score (quality of life index) were calculated and stored. Results: There were 80 subjects in all. The mean ± SD of the Ferriman-Gallwey score was reduced from 7.05 ± 2.27 to 4.91 ± 2.41, P < 0.001. The mean ± SD of the Beck depression score was reduced from 13.3 ± 8.7 to 10.2 ± 8.4, P < 0.001, and the mean ± SD of the DLQI score decreased from 5.6 ± 5.2 to 3.5 ± 2.3, P < 0.001. No significant complications were reported. Conclusion: LAHR can improve hirsutism-related depression and degradation of quality of life, as well as hirsutism physical signs.

Comparison of topical 8-methoxypsoralen and narrowband ultraviolet B with narrowband ultraviolet B alone in treatment-resistant sites in plaque-type psoriasis: a placebo-controlled study.

BACKGROUND: Combination of topical methoxsalen and narrowband ultraviolet B (NBUVB) was shown to be more effective than NBUVB alone in treating plaque-type psoriasis. OBJECTIVE: To find out whether topical methoxsalen and NBUVB had any benefit in induction of remission on treatment-resistant plaques of psoriasis on the legs in comparison with NBUVB alone. METHODS: Ten patients were included. Two symmetric lesions with similar Psoriasis Severity Index score on the lower legs were randomly assigned to be treated with cold cream as placebo or 0.1% 8-methoxypsoralen (8MOP) cream 15 min before phototherapy with NBUVB. Phototherapy was given three times per week for up to three months. Severity scores were recorded each week and side effects were observed before each session. RESULTS: Significant decrease in the severity score was observed in both groups (P-value < 0.001), but none of the lesions cleared completely at the end of the study. The decrease of the score in the 8MOP arm was greater than the control arm; however, the difference was not significant. The only side effect was pigmentation that occurred in all of the 8MOP-treated patients after 2 weeks. CONCLUSION: We could not confirm any significant benefit of topical methoxsalen and NBUVB in comparison to NBUVB alone in treating resistant plaques of psoriasis on the legs.

Clinical Significance of Non-invasive Skin Autofluorescence Measurement in Patients with Diabetes: A Systematic Review and Meta-analysis.

BACKGROUND: Advanced glycation end products (AGE), one of the main factors causing diabetic end-organ damage, accumulate in long half-life proteins, such as skin and cartilage collagen. AGE measurement may offer additional evidence to predict diabetic vascular complications. Skin autofluorescence (SAF) is suggested as a non-invasive, quick, and reliable method to measure tissue AGE level. The aim of this study was to review and evaluate evidence on the clinical validation of SAF measurement in diabetes mellitus (DM) patients. METHODS: In this systematic review and meta-analysis, we searched "PubMed" (MEDLINE) and "Cochrane" databases from their inception to 10 August 2021 for observational studies concerning SAF measurement in diabetic patients. The following key terms were used in advanced searching: "Diabetes", "Diabetes Mellitus"," DM", "Glycation ", "Advanced Glycation End product", "AGE", "skin autofluorescence", "SAF". Published studies that included DM patients and estimated their AGE using SAF were considered eligible for meta-analysis. Articles that were editorials, study proposals, congress posters, or case reports and were not on human subjects were excluded. We used a random-effect models for meta-analyzing the clinical validation of SAF in DM with particular emphasis on chronic diabetes complications. FINDINGS: We identified 881 records and twenty-nine records fulfilled our eligibility criteria and were included in the systematic review and meta-analysis. A statistically significant correlation was found between SAF and diabetes last HbA1c 0.21(0.13,0.28) in studies with substantial heterogeneity (I2=77.99%, p<0.05). Nevertheless, a significant positive association between SAF level and diabetic retinopathy (DR) [(OR= 1.05, 95% CI=1.03,1.08), (I2=63.78%, p<0.05)], diabetic peripheral neuropathy (DPN) [(OR= 1.11, 95%CI= 1.06,1.16), (I2=79.17%, p<0.05)], diabetic nephropathy (DNP) [(OR= 1.08, 95%CI: 1.05,1.11), (I 2 =65.36%, p<0.05)] and diabetic macrovascular events (D-MVE) [(OR=1.08, 95%CI=1.05,1.11) (I2=67.32, p<0.05)] were found. INTERPRETATION: Our study confirmed the significance of SAF measurement as a non-invasive surrogate marker of DM micro and macrovascular complications. Skin AGE estimation may be a useful factor for the prediction and early detection of irreversible DM complications. More studies with larger populations and longer follow-up periods are required.

An enlarging scaly plaque localized on the previous keloid of the chest.

Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma (CTCL). It may arise rapidly in a scar or keloid, presumably due to a long-standing proliferative state or autoimmune theory. There should be a low threshold for performing a skin biopsy if unusual lesions develop at those sites.