Descriptive and Concordance Data for Asynchronous Teledermatology Consultations for Dermatitis: A Retrospective Study.

Background: Implementation of teledermatology for assessing dermatitis patients provides comparable diagnostic and management outcomes to in-person visits, but studies on consumer to physician asynchronous teledermatology (eDerm) consults submitted by patients in large dermatitis cohorts are limited. The objective of this study was to retrospectively assess associations of eDerm consults with diagnostic accuracy, management, and follow-up in a large cohort of dermatitis patients. Methods: One thousand forty-five eDerm encounters between April 1, 2020, and October 29, 2021, recorded in the University of Pittsburgh Medical Center Health System Epic electronic medical record were reviewed. Descriptive statistics and concordance were analyzed using chi-square. Results: Asynchronous teledermatology modified/changed treatment in 97.6% of cases and had the same diagnosis between teledermatology and in-person follow-up in 78.3% of cases. Patients following up in the time line requested were more likely to follow-up in person (61.2% vs. 43.8%) than those who did not. Patients with intertriginous dermatitis (p = 0.003), preexisting conditions (p = 0.002), who required follow-ups (<0.0001), and moderate-high severity scores of 4-7 (p = 0.019) were more likely to follow up in the time line requested. Limitations: Lack of similar in-person visit data did not allow us to compare descriptive and concordance data between eDerm and clinic visits. Conclusions: eDerm offers a quick accessible solution to provide comparable dermatologic care for patients with dermatitis.

Subepidermal calcified nodule presenting as a cutaneous horn: two cases and a review of the literature.

Subepidermal calcified nodules are an uncommon subtype of idiopathic calcinosis cutis. Morphologically, this entity typically present as a single, well-circumscribed, white-yellow nodule. Based on clinical appearance alone, subepidermal calcified nodules are frequently misdiagnosed and often requires histological confirmation. We describe two cases of subepidermal calcified nodules presenting atypically as cutaneous horns. Subepidermal calcified nodules presenting as a cutaneous horn has rarely been reported; on review, there are fewer than 10 such cases have been described within the past 30 years. The cases described here illustrate the clinical variety and should increase awareness of subepidermal calcified nodules presented.

CD5+ Primary Cutaneous Diffuse Large B-Cell Lymphoma, Leg Type, Presenting as an Asymptomatic Nodule.

Primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL-LT), is a rare and aggressive variant of primary cutaneous lymphoma that typically expresses B cells as well as MUM1/IRF4, BCL2, and FOXP1, whereas BCL6 may be present or undetectable. We present a case of CD5+ PCDLBCL-LT presenting as a 6 mm pink-bluish nodule on the mid-left thigh, which was concerning for basal cell carcinoma. The histological examination reveals the presence of an intradermal proliferation of large, atypical CD5+, CD20+ BCL2+, BCL6+, MUM-1+, and Cyclin-D1+ lymphocytes in a nodular, diffuse interstitial and perivascular distribution. Because the patient presented with a small, single nodule, the systemic treatment of multiagent chemotherapy was avoided and localized electron beam radiation therapy with rituximab was initiated instead, achieving complete response. Early identification of PCDLBCL-LT is key for maximal therapeutic benefit and prognosis; it is important to consider PCDLBCL-LT on the differential when evaluating small, single nodules on the lower extremities of elderly patients.

A multimodal sensing ring for quantification of scratch intensity.

BACKGROUND: An objective measurement of chronic itch is necessary for improvements in patient care for numerous medical conditions. While wearables have shown promise for scratch detection, they are currently unable to estimate scratch intensity, preventing a comprehensive understanding of the effect of itch on an individual. METHODS: In this work, we present a framework for the estimation of scratch intensity in addition to the detection of scratch. This is accomplished with a multimodal ring device, consisting of an accelerometer and a contact microphone, a pressure-sensitive tablet for capturing ground truth intensity values, and machine learning algorithms for regression of scratch intensity on a 0-600 milliwatts (mW) power scale that can be mapped to a 0-10 continuous scale. RESULTS: We evaluate the performance of our algorithms on 20 individuals using leave one subject out cross-validation and using data from 14 additional participants, we show that our algorithms achieve clinically-relevant discrimination of scratching intensity levels. By doing so, our device enables the quantification of the substantial variations in the interpretation of the 0-10 scale frequently utilized in patient self-reported clinical assessments. CONCLUSIONS: This work demonstrates that a finger-worn device can provide multidimensional, objective, real-time measures for the action of scratching.

Chronic itch can be caused by many medical conditions including eczema and psoriasis. Itch leads to scratching behaviors that can affect a person's sleep, productivity, mood, and overall well-being. We developed a ring device that can be placed on a person's finger to measure the intensity of scratching. Different types and intensities of scratching behavior could be distinguished in human volunteers. Further development of this device should enable more consistent and comprehensive measurement of scratching behaviors and help doctors and patients to better understand, and treat, chronic itch.

Performance Evaluation of Gum Gellan-Based Hydrogel as a Novel Adsorbent for the Removal of Cationic Dyes: Linear Regression Models.

In this work, the suitability and efficacy of the previously reported biodegradable gellan gum (GG)-based hydrogel have been thoroughly investigated with respect to the adsorption mechanisms of malachite green (MG) and methylene blue (MB) dyes. The dyes' removal from aqueous solutions using GG-cl-poly(AA) as an adsorbent material has been studied in a discontinuous system with respect to contact time, dose, pH, and temperature. The synthesized hydrogel was characterized by FT-IR, TGA, XRD, 1H NMR, and FE-SEM. The adsorption capacity of GG-cl-poly(AA) hydrogel was investigated at different pH solutions (3, 7, and 10), and it was found that neutralized charge plays a crucial role in the enhancement of dye removal. To better understand the behavior of the GG-cl-poly(AA) hydrogel in adsorbing model dyes, adsorption kinetics, isotherms, and thermodynamics were also investigated. The values of qmax for MG and MB were obtained to be 552.48 and 531.9 mg g-1. In addition, the influence of NaCl concentration on adsorption efficiency was investigated, and it was found that as the ion concentration increased, the effectiveness of the adsorption process dropped. Moreover, the synthesized hydrogel's potential application in the adsorption and separation of dyes from wastewater is enhanced by the reusability investigations conducted in convenient conditions. As a result, it is possible to conclude that reusing GG-cl-poly(AA) hydrogel as a low-cost, easy-to-handle, nontoxic material in an industrial wastewater treatment plant's adsorption process can provide a number of advantages, including high efficiency for MG and MB removal and cost savings on overall treatment plant operations.

DOE-based synthesis of gellan gum-acrylic acid-based biodegradable hydrogels: screening of significant process variables and in situ field studies.

The current study uses the free radical graft copolymerization of acrylic acid as a monomer, N,N-methylene-bis-(acrylamide) as a crosslinker and ammonium persulfate as an initiator to synthesise GG-cl-poly(AA) hydrogels based on gellan gum utilising response surface methodology (RSM). A full factorial design was used to obtain the greatest percent swelling (P s), and key process variables were determined using the Pareto chart. To make the procedure cost-effective, a multiple regression model employing ANOVA projected a linear model with a maximum percentage swelling of 556 at the lowest concentration of all three studied factors. As a result, the sequential experimental design was successful in obtaining two-fold increases in the percentage swelling in a systematic way. An RSM-based central composite design was used to optimize the percentage swelling of the three most important synthesis parameters: initiator concentration, monomer concentration, and crosslinker concentration. The best process conditions are 7.3 mM L-1 initiator, 44 µM L-1 monomer, and 21.6 mM L-1 crosslinker. The effective synthesis of GG-cl-poly(AA) was validated by Fourier transform infrared spectroscopy (FTIR), X-ray diffraction, field emission scanning electron microscopy (FE-SEM), and 1H-nuclear magnetic resonance. The swelling behavior of GG-cl-poly(AA) in water and saline solutions, as well as its water retention capability, was investigated. In comparison to distilled water, the swelling potential of optimized hydrogel was shown to be significantly reduced in saline solutions. The addition of GG-cl-poly(AA) significantly improved the moisture properties of plant growth media (clay, sandy, and clay-soil combination), implying that it has great potential in moisture stress agriculture. GG-cl-poly(AA) biodegradation was studied by soil burial and vermicomposting methods. The composting approach showed 89.95% deterioration after 22 days, while the soil burial method showed 86.71% degradation after 22 days. The synthesized hydrogel may be beneficial for agricultural applications because of its considerable degradation behaviour, strong water retention capacity, low cost, and environmental friendliness.

A Review of Adsorbents for Heavy Metal Decontamination: Growing Approach to Wastewater Treatment.

Heavy metal is released from many industries into water. Before the industrial wastewater is discharged, the contamination level should be reduced to meet the recommended level as prescribed by the local laws of a country. They may be poisonous or cancerous in origin. Their presence does not only damage people, but also animals and vegetation because of their mobility, toxicity, and non-biodegradability into aquatic ecosystems. The review comprehensively discusses the progress made by various adsorbents such as natural materials, synthetic, agricultural, biopolymers, and commercial for extraction of the metal ions such as Ni2+, Cu2+, Pb2+, Cd2+, As2+ and Zn2+ along with their adsorption mechanisms. The adsorption isotherm indicates the relation between the amount adsorbed by the adsorbent and the concentration. The Freundlich isotherm explains the effective physical adsorption of the solute particle from the solution on the adsorbent and Langmuir isotherm gives an idea about the effect of various factors on the adsorption process. The adsorption kinetics data provide valuable insights into the reaction pathways, the mechanism of the sorption reaction, and solute uptake. The pseudo-first-order and pseudo-second-order models were applied to describe the sorption kinetics. The presented information can be used for the development of bio-based water treatment strategies.

Fatal Disseminated Mucormycosis in a Hematological Immunocompromised Patient with Extensive Voriconazole Exposure: A Case Report and Review of the Literature.

Disseminated mucormycosis is a rare, opportunistic, and aggressive infection typically presenting in immunocompromised patients. Herein, we report a 55-year-old male with a past medical history of Philadelphia-negative B-cell acute lymphoblastic leukemia who presented with a 2-month history of non-painful necrotic ulcers on the nose, knuckles, elbow, foot, and scrotum following 3 months of voriconazole (VRC) exposure in the setting of an unrelated fungal pneumonia. Our case reinforces the virulent and often fatal nature of the disease amongst immunocompromised patients, along with extensive VRC exposure as a possible supplementary risk factor. Disseminated cutaneous mucormycosis should be regarded as a differential diagnosis in all immunocompromised patients, especially those with hematologic malignancies or a history of VRC use, who present with cutaneous ulcerations and eschars.

Shifting from volume to economic value in virtual water allocation problems: A proposed new framework and methodology.

PURPOSE: The water footprint provided a full methodology to operationalise the virtual water concept (the volume of water used along a supply chain to produce products and services). A key theme in the water footprint literature is the efficient allocation of water resources at the global scale given the feasibility of trading water intensive commodities from water rich to water poor areas: this is an economic problem of resource allocation between alternative and competing demands, albeit with a novel international component. Moreover, given that price signals indicating relative scarcity are usually either absent or distorted for water, it is also a problem that can be seen through the lens of environmental (or non-market) valuation. However, to date environmental valuation has not been used to inform the efficient use and allocation of water within and between the different locations encompassed by international supply chains. METHODS: Drawing on an agri-food supply chain framework that we propose in this paper, we begin by conceptualising the economic values that accrue to water consumption (blue and green water) and degradation (grey water) at different points along a supply chain. Based on this conceptualisation, we assess the extent to which it is possible to approximate these economic values by relying on existing secondary data on the shadow value of water in different contexts. The use of secondary data in this way is known as benefit (or value) transfer. To achieve this, 706 unit estimates of the economic value of water are collected, standardised and reviewed encompassing off-stream water applications (agriculture, industry and municipal) and in-stream ecosystem services (waste assimilation, wildlife habitat, recreation, hydrological functions and passive uses). From this, a proposed methodology for valuing virtual water is presented and illustrated using the case study of global durum wheat pasta production. RESULTS: The case study shows the total value of the virtual water used to produce one tonne of durum wheat pasta ($212). More importantly, the case study also highlights how variations in economic value between multiple locations where durum wheat is cultivated (Saskatchewan $0.10 m3, Arizona $0.08 m3 and Baja California $0.24 m3) indicate relative water scarcity and thus impact, as well as the potential for a more efficient allocation of virtual water. CONCLUSIONS: The main conclusion from this research is that when geographical disparities in the economic value of water use within a supply chain are accounted for, what was perhaps considered sustainable in volume terms, might not, in fact, represent the optimal allocation. However, future research opportunities highlight the need for additional data collection on the economic value of water in several contexts. This additional data would help the environmental valuation community to undertake a more comprehensive and robust approach to virtual water valuation. This paper is accompanied by the Data in Brief article entitled "Dataset on the in-stream and off-stream economic value of water."

Dataset on the in-stream and off-stream economic value of water.

This dataset contains 706 estimates of the economic value of water; it has been compiled from published sources. Economic values are provided for three off-stream uses (agriculture/irrigation, industry, and municipal) and three in-stream ecosystem services (recreation, waste assimilation, and wildlife habitat). The dataset covers per period and capitalised asset values. All value estimates have been standardised in USD (2014) per acre-foot. The data accompany the research article entitled "Shifting from volume to economic value in virtual water allocation problems: a proposed new framework and methodology" [1]. The dataset can be used to facilitate benefits (or value) transfer.

Neem gum based pH responsive hydrogel matrix: A new pharmaceutical excipient for the sustained release of anticancer drug.

The present research work was aimed to synthesize neem gum-based site-specific drug delivery device for anticancer drug methotrexate at different pH condition. The hydrogel-based drug delivery device was synthesized by optimizing reaction parameters using a factorial design approach response surface method. This model comprised of various sets of reactions with varying concentrations of solvent, crosslinker, initiator and monomer under microwave radiation. Characterization of the candidate hydrogel was done using UV-visible spectrophotometer, FTIR, SEM, Raman, and XRD techniques. The release profile of the hydrogels network was studied through a methotrexate under different pH conditions. The drug encapsulation capacity was found to be around 93% and 90% in pH 7.4 and 6.8. Drug release through the synthesized hydrogel matrix was found to show non-Fickian behaviour at each medium. The hydrogel network showed less release in pH 6.8 than pH 7.4, suggesting that hydrogels may be suitable drug carriers for release of anticancer drug delivery system. Hemolysis testing was also done to check the compatibility of the synthesized drug delivery device with the four different blood samples. Hemolysis was found to be less than 1% in the case of all blood groups, which indicates that the synthesized candidate polymers are biocompatible with all blood groups.

Connective Tissue Nevi: A Review of the Literature.

Connective tissue nevi (CTN) are hamartomas of the dermis, with the 3 main components being collagen, elastin, and proteoglycans. Each subtype can present as a solitary lesion or multiple lesions. They could present as part of systemic diseases or inherited disorders. This article provides a comprehensive literature review of the different types of CTN, their clinical presentations, associations, and treatment options. Treatment options for 56 lesions were reviewed. Fifty-two percent of lesions were present in males, and the age range at the time of presentation was wide (1.6-80 years). Management varied according to CTN subtypes. Most lesions (14) received topical or intralesional treatment with corticosteroids, followed by surgical removal of lesions (12), whereas the remaining lesions were clinically monitored.

MiR-21 and miR-205 are induced in invasive cutaneous squamous cell carcinomas.

Cutaneous squamous cell carcinoma (cSCC) is a malignant proliferation of keratinocytes with an uncertain molecular basis causing significant morbidity. MicroRNAs (miRs) are small RNA molecules that regulate gene expression on post- transcriptional level. MiRs are critical to various biological processes. To determine if miRs play a role in pathogenesis of invasive cSCC, we collected patients' specimens from in situ and invasive cSCC (n = 19) and examined miRs expression levels using qPCR. Specifically, we evaluated miR-21, miR-103a, miR-186, miR-200b, miR-203, and miR-205 expression levels due to their role in skin biology and epithelial to mesenchymal transition. MiR levels were compared between in situ and invasive cSCCs. We found statistically significant (p ≤ 0.05) upregulation of miR-21 and miR-205 in invasive cSCC compared to cSCC in situ. We concluded that miR-21 and miR-205 may have diagnostic value in determining the invasive properties of cSCCs and that each cSCC displays unique miR profile, underscoring the possibility of personalized medicine approach in developing potential novel, less invasive treatments.