Gaining exposure on perceptions of sunscreen: a national survey of melanoma patients.

Melanoma incidence is increasing. We ascertained perceptions regarding sunscreen and factors influencing choice in patients with melanoma. A survey was distributed to all the supporters of a melanoma patient support group. 571 responses were received across six weeks. Most (79.2%; n=452) indicated they knew how much sunscreen to apply; the most popular frequency of application was once daily (32%, n=180). The most popular cosmetic benefit respondents indicated was reduced redness on sun-exposed areas of skin (73.2%; n=418). Most (96.7%; n=552) agreed more education is needed regarding importance of wearing sunscreen. The three most popular factors in influencing sunscreen choice were SPF more than 50 (n=299; 52.4%), recommendation by a dermatologist (n=267; 46.8%) and price (n=262; 45.9%). Sustainable package design (n=45; 7.9%) and ethical sourcing of ingredients (n=65; 11.4%) were not ranked highly. Given 42% (n=240) only applied sunscreen during sunshine, an education campaign is required. Industry should consider public education regarding sustainability. A further study ascertaining views and perceptions of sunscreen in the non-melanoma cohort is strongly encouraged.

Topical sirolimus in dermatology: a systematic review.

CONTEXT: Topical sirolimus is increasingly utilised off-license to manage various dermatological conditions whilst avoiding typical adverse effects associated with systemic sirolimus. However, widespread use is limited by a highly heterogeneous evidence base of mixed quality. OBJECTIVE: to evaluate the current evidence base for the indications, efficacy and safety profile for topical sirolimus in dermatology. DATA SOURCES: A literature search was conducted from 2005 to July 4th, 2023, of English language studies, with the following databases consulted: MEDLINE, PubMed, Embase, CENTRAL and EBSCO. Key words included 'topical', 'rapamycin', 'sirolimus' and 'dermatology'. DATA EXTRACTION: Data on drug efficacy, concentration, side effects, co-interventions and follow up were extracted. RESULTS: The search identified 202 studies; 71 studies met the inclusion criteria. Efficacy of topical sirolimus was demonstrated in facial angiofibromas (799 patients) compared to placebo across multiple randomised controlled trials with a predominant concentration of 0.1%. Evidence was mixed for sirolimus use in port-wine stains (61 patients), with evidence of effectiveness in combined sirolimus and pulsed-dye laser. Multiple case reports demonstrated clinical improvement with topical sirolimus use in cutaneous vascular abnormalities (33 patients) at a higher concentration of 1%. Other applications of topical sirolimus were predominantly case reports demonstrating generally favourable outcomes. Topical sirolimus was generally well tolerated - most reported adverse effects were localised irritation and pruritus. Ointment-based preparations and once-daily dosing appeared to confer a better side effect profile. CONCLUSION: Most high-quality data pertain to the efficacy of topical sirolimus in treating facial angiofibromas in tuberous sclerosis. Outcomes are generally promising in other indications and good tolerability, but data quality is mixed.

Intraoperative somatosensory evoked potential (SEP) monitoring: an updated position statement by the American Society of Neurophysiological Monitoring.

Somatosensory evoked potentials (SEPs) are used to assess the functional status of somatosensory pathways during surgical procedures and can help protect patients' neurological integrity intraoperatively. This is a position statement on intraoperative SEP monitoring from the American Society of Neurophysiological Monitoring (ASNM) and updates prior ASNM position statements on SEPs from the years 2005 and 2010. This position statement is endorsed by ASNM and serves as an educational service to the neurophysiological community on the recommended use of SEPs as a neurophysiological monitoring tool. It presents the rationale for SEP utilization and its clinical applications. It also covers the relevant anatomy, technical methodology for setup and signal acquisition, signal interpretation, anesthesia and physiological considerations, and documentation and credentialing requirements to optimize SEP monitoring to aid in protecting the nervous system during surgery.

Sleep deprivation and the skin.

Sleep is an under-evaluated symptom when assessing patients with cutaneous disease. Consequently, the relationship between sleep deprivation and disease burden is often not considered. The focus of our review article is to explore the bidirectional relationship between sleep and cutaneous disease investigating the disruption in circadian rhythmicity and skin homeostasis. Management strategies should focus on optimizing disease control coupled with improving sleep hygiene.

A systematic review of the uses of metformin in dermatology.

Metformin is an established staple drug in the management of Type 2 diabetes mellitus. In this systematic review, we sought to establish the clinical utility of metformin in a range of dermatological conditions. The pathophysiology of acne vulgaris and polycystic ovarian syndrome (PCOS) is well suited to the pharmacological profile of metformin, and we found evidence for its efficacy in managing these conditions. We found some evidence for the use of metformin particularly in acne and PCOS; however, the evidence base is of mixed quality. There is scope for clinicians to consider metformin as an adjunct therapy in acne and PCOS. There is generally insufficient evidence to recommend metformin in other dermatological conditions.

MIMO Radio Frequency Identification: A Brief Survey.

In this paper, we briefly look at the latest state-ot-the-art in the domain of multi-input multi-output (MIMO) radio frequency identification (RFID) systems while detailing the work done in the domain of anti-collision, range enhancements, bit error rate (BER) improvements and security. Various passive ultra-high frequency (UHF) RFID implementations are considered that employ multiple antennas at the reader and single or multiple antennas at each tag. We look at several recent works those explored MIMO for RFID receivers. When using MIMO at the backscatter channel, significant improvements can be achieved in the BER as well as range extension. With the extra reliability and increased throughput, such systems can be deployed in many important applications like large tag reading scenarios and accurate tracking. Increased throughput is directly dependent on estimation of tag quantity in a bulk reading environment and usually estimators designed for single antenna systems under-perform in such settings causing low signal to noise ratio (SNR) when employed in MIMO systems where tag signal overlapping can happen more often. One of the key challenges is to keep the design of the RFID tag simple, cutting cost and power requirement when employing anti-collision schemes. We provide a brief survey in some of the recent developments related to MIMO RFID systems, the protocols and algorithms used, and improvements achieved.

Utilization of protein isolates from rohu (Labeo rohita) processing waste through incorporation into fish sausages; quality evaluation of the resultant paste and end product.

BACKGROUND: Fish processing waste could be valorized by recuperating the nutrients for human consumption. Employing a suitable process would address the pollution problems associated with its dumping and would contribute to food security. In this study, protein isolates obtained from rohu (Labeo rohita) processing waste through the pH shift process (pH 13.0) were valorized through incorporation into pangasius (Pangasius pangasius) mince sausages (0.0, 50, 100, 250, and 500 g kg-1 ). These sausages were analyzed for their proximate composition, and their physical and eating quality. RESULTS: Increasing the isolate content (11.57% to 16.14%) in sausages increased their protein content and whiteness values (P < 0.05). At 250 g kg-1 level, the cooking yield was maximum, and the expressible fluid content of paste was minimum. Moreover, adding rohu protein isolates in pangasius mince increased the expressible moisture and decreased its folding and gel strength values (P < 0.05). The gel strength values were highest for the sausages without isolates (2648.67 g cm). In contrast, in the sausages containing 250, 100, and 500 g kg-1 isolate, the values were determined to be 847.88, 731.21, and 611.06 g cm, respectively. Replacing pangasius mince with rohu protein isolates had a non-significant effect on the sensory attributes of the sausages. CONCLUSION: Replacing pangasius mince with rohu protein isolates at 250 g kg-1 resulted in superior quality sausages compared with other levels tested. Incorporating rohu protein isolates in fish sausages improved the nutritional value without significantly reducing their eating quality. The findings of this study indicate promising potential for developing nutrient-rich foods using fish protein isolates. © 2021 Society of Chemical Industry.

Intralesional methotrexate in dermatology: Diverse indications and practical considerations.

Intralesional methotrexate (IL-MTX) is a long-established treatment, which is arguably underutilized by dermatologists. We describe the underlying evidence base and practical considerations for its broad range of cutaneous indications, including in cutaneous oncology (keratoacanthomas, squamous cell carcinomas, lymphomas), inflammatory dermatology (nail psoriasis, plaque psoriasis, pyoderma gangrenosum, cutaneous Crohn's disease, amyloidosis), cutaneous infections (viral warts) and for treatment of filler complications. In certain circumstances, IL-MTX can be more efficacious and less invasive than other treatments, with fewer adverse effects. Dermatologists should consider using IL-MTX for a range of recalcitrant cutaneous conditions, particularly for those patients not amenable to surgery or systemic therapy.

5-Fluorouracil in Dermatology: The Diverse Uses Beyond Malignant and Premalignant Skin Disease.

BACKGROUND: 5-fluorouracil (5-FU) is widely used for treatment of malignant and premalignant skin cancers; however, its use in other common cutaneous conditions has been less widely reported. OBJECTIVE: We investigated the off-label uses of 5-FU beyond malignant and premalignant skin disease. METHODS: We conducted a literature review searching multiple databases to evaluate the evidence for the off-label uses of 5-FU. The level of evidence was evaluated and selected accordingly listing the studies with the highest level of evidence first using the Oxford Centre of Evidence-Based Medicine 2011 guidance. RESULTS: We found underlying evidence to support the use of 5-FU for a wide range of noncancerous cutaneous indications including scarring (keloid, hypertrophic), pigmentary disorders (vitiligo, idiopathic guttate hypomelanosis), cutaneous infections (viral warts, molluscum contagiosum), inflammatory dermatoses (Darier's disease, Hailey-Hailey disease and sarcoidosis), and cosmetic indications (photoaging, treatment of filler nodules and granulomas). CONCLUSION: In selected patients, 5-FU can be as effective as more established treatments, with fewer side-effects.

The top 10 cosmeceuticals for facial hyperpigmentation.

Disorders of facial hyperpigmentation including melasma, postinflammatory hyperpigmentation and solar lentigines are common cutaneous conditions which can have a huge impact on patients' quality of life and often prove difficult to treat. The nascent market of cosmeceutical options provides a potentially safer and efficacious alternative for treating these challenging conditions. These can be used alone or in combination with other established treatments. Many cosmeceutical products are thought to work through inhibition of tyrosinase, a key enzyme of melanogenesis. We discuss the mode of action and provide an up-to-date review of the underlying evidence base for the top 10 cosmeceutical products for hyperpigmentation and melasma. Possible safer and more efficacious cosmeceutical therapies we discuss include thiamidol, kojic acid, vitamin C, arbutin, retinol, nicotinamide, ferulic acid, resorcinol, licorice root extract, and soy.

Hyaluronidase in Dermatology: Uses Beyond Hyaluronic Acid Fillers.

Hyaluronidase is mostly widely recognized for its off-label use in correction of complications of hyaluronic acid fillers. However, its utility in other aspects of dermatology is less widely acknowledged. We describe the varied uses of hyaluronidase in dermatology and the underlying evidence base for its dermatological indications. This includes its uses in enhancing drug delivery (for local anesthesia, keloid and hypertrophic scars, and for Kaposi’s sarcoma), in the treatment of disorders associated with mucin deposition (myxedema, scleroderma, scleredema, and cutis verticis gyrata) and its potential uses in surgery (as a pre-operative adjuvant in dermatofibrosarcoma protuberans, for periorbital edema, and for hematomas). In select circumstances, hyaluronidase might be more efficacious than more established treatments with fewer adverse effects. We propose hyaluronidase as the latest addition to our global dermatological armamentarium and implore dermatologists to consider its use to enhance their practice. J Drugs Dermatol. 2020;19(10):993-998. doi:10.36849/JDD.2020.5416.

Rosacea and the gastrointestinal system.

Rosacea is a common skin condition characterised by erythema, papules and pustules. Increasing evidence suggests that the gut-skin axis is implicated in the pathogenesis of rosacea. Sufficient evidence exists to support the notion that the gut microbiome plays a role in the inflammatory cutaneous response and there appear to be associations with small intestinal bacterial overgrowth and Helicobacter pylori infection. A dysbiotic microbiome and an innate immune system dysregulation contribute to the pathophysiology of rosacea, and further exploration of their roles is warranted. Greater understanding of this condition and the effect of the gut-skin axis could allow for more efficacious and timely treatment. This article reviews our current findings and understanding in the skin and gut relationship in rosacea.

Practice guidelines for the supervising professional: intraoperative neurophysiological monitoring.

The American Society of Neurophysiological Monitoring (ASNM) was founded in 1989 as the American Society of Evoked Potential Monitoring. From the beginning, the Society has been made up of physicians, doctoral degree holders, Technologists, and all those interested in furthering the profession. The Society changed its name to the ASNM and held its first Annual Meeting in 1990. It remains the largest worldwide organization dedicated solely to the scientifically-based advancement of intraoperative neurophysiology. The primary goal of the ASNM is to assure the quality of patient care during procedures monitoring the nervous system. This goal is accomplished primarily through programs in education, advocacy of basic and clinical research, and publication of guidelines, among other endeavors. The ASNM is committed to the development of medically sound and clinically relevant guidelines for the performance of intraoperative neurophysiology. Guidelines are formulated based on exhaustive literature review, recruitment of expert opinion, and broad consensus among ASNM membership. Input is likewise sought from sister societies and related constituencies. Adherence to a literature-based, formalized process characterizes the construction of all ASNM guidelines. The guidelines covering the Professional Practice of intraoperative neurophysiological monitoring were initially published January 24th, 2013, and subsequently that document has undergone review and revision to accommodate broad inter- and intra-societal feedback. This current version of the ASNM Professional Practice Guideline was fully approved for publication according to ASNM bylaws on February 22nd, 2018, and thus overwrites and supersedes the initial guideline.