A qualitative review of social media sharing and the 2022 monkeypox outbreak: did early labelling help to curb misinformation or fuel the fire?

BACKGROUND: Misinformation, defined as a claim that is false or misleading, considers information that is both shared with the intention of causing harm, and information that is false with no ill intent. Early attempts to downplay the risk of monkeypox (mpox) by singling out men who have sex with men (MSM) may have had the ill effect of stigmatising this group in discussions online. The aim of this study was to evaluate themes present on Instagram related to the 2022 mpox outbreak under #monkeypox. Specifically, this study sought to determine if the pervasive narratives surrounding the coronavirus disease 2019 (COVID-19) pandemic, particularly related to government mistrust and conspiracy, were penetrating discussions about mpox. METHODS: A total of 255 posts under #monkeypox (the top 85 posts per day, every 10days in July 2022) were collected on Instagram. A content analysis approach, which seeks to quantify themes present, was utilised to evaluate themes present in posts under #monkeypox. RESULTS: Contrary to previous research investigating public health misinformation online, the majority of posts under #monkeypox were categorised as accurate information (85.9%). Moreover, a surprising number of posts were classified as anti-misinformation (32.9%), whereby users actively worked to debunk false information being shared online related to mpox. CONCLUSIONS: We hypothesise that early labelling of the disease as one that strictly affects online MSM communities has resulted in the digital community coming together to fact-check and debunk misinformation under #monkeypox on Instagram.

Congenital bullous syphilis in a newborn: A novel approach to diagnosis using immunohistochemical staining on a blister roof.

We describe a rare presentation of congenital bullous syphilis in a premature neonate born with extensive skin desquamation. The newborn was noted to have diffuse erythema with widespread, superficial skin desquamation in addition to plantar bullae and erosions, and an absence of mucosal involvement. Immunohistochemical syphilis diagnostic staining was performed on a blister roof, highlighting a novel diagnostic approach for congenital bullous syphilis.

Children's Independent Mobility, School Travel, and the Surrounding Neighborhood.

INTRODUCTION: Children's active travel to and from school (AST) and children's independent mobility (CIM) are consistently positively associated with physical activity (PA); however, few researchers have investigated associations between objective measures of the environment and indicators of AST and CIM in national samples. METHODS: A national sample of 2,067 Canadian parents of 7- to 12-year-old children was recruited in December 2020. Regression analyses were used in 2023 to assess the association between geographic information system measures of park density, blue space, population density, greenspace, intersection density, and CIM and AST to and from school. RESULTS: Children in areas with high versus low park density (>0.025 vs. ≤0.025) had higher odds of travel to school via active modes (OR: 1.47 [1.14, 1.91], p=0.003). Children in neighborhoods in the highest quartile for neighborhood greenspace (Normalized Difference Vegetation Index) were more likely to travel to home actively than those in areas of lower greenspace (OR: 1.70 [1.18, 2.45], p=0.004). On average, children living in areas in the highest versus the lowest quartile for intersection density were more likely to engage in AST to (OR: 2.43 [1.58, 3.75], p<0.001) and from (OR: 2.77 [1.80, 4.29], p<0.001) school. CONCLUSIONS: The observed associations underscore a need for city planners and policymakers to ensure sufficient access to parks and neighborhood greenspace, especially if findings are confirmed in longitudinal studies. More research is needed to investigate the role of intersection density in supporting AST and CIM.

Psoriatic Presentation of Human Immunodeficiency Virus (HIV).

Human immunodeficiency virus (HIV) is a potentially life-threatening single-stranded RNA lentivirus that attacks the body's immune system by infecting CD4 T lymphocytes. If untreated, HIV infection can progress to acquired immunodeficiency syndrome (AIDS).1.2 With the US prevalence of around 12.6 per 100,000 individuals, HIV positivity remains undiagnosed among much of the population.3 The most common presentation of HIV includes flu-like manifestations, such as fever, malaise, diarrhea, weight loss, headache, and muscle aches; however, it is also known to present as other diseases, including psoriasis.1.

Multiple paternity is related to adult sex ratio and sex determination system in reptiles.

The adult sex ratio (ASR, the proportion of males in the adult population) is an emerging predictor of reproductive behaviour, and recent studies in birds and humans suggest it is a major driver of social mating systems and parental care. ASR may also influence genetic mating systems. For instance male-skewed ASRs are expected to increase the frequency of multiple paternity (defined here as a clutch or litter sired by two or more males) due to higher rates of coercive copulations by males, and/or due to females exploiting the opportunity of copulation with multiple males to increase genetic diversity of their offspring. Here, we evaluate this hypothesis in reptiles that often exhibit high frequency of multiple paternity although its ecological and life-history predictors have remained controversial. Using a comprehensive dataset of 81 species representing all four non-avian reptile orders, we show that increased frequency of multiple paternity is predicted by more male-skewed ASR, and this relationship is robust to simultaneous effects of several life-history predictors. Additionally, we show that the frequency of multiple paternity varies with the sex determination system: species with female heterogamety (ZZ/ZW sex chromosomes) exhibit higher levels of multiple paternity than species with male heterogamety (XY/XX) or temperature-dependent sex determination. Thus, our across-species comparative study provides the first evidence that genetic mating system depends on ASR in reptiles. We call for further investigations to uncover the complex evolutionary associations between mating systems, sex determination systems and ASR.

Diagnosis of Mycosis Fungoides after Dupilumab Treatment for Atopic Dermatitis.

A 46-year-old woman with a medical history of pseudoxanthoma elasticum presented with atopic dermatitis (AD) refractory to topical therapies (topical steroids, tacrolimus, and calcitriol), phototherapy, and excimer laser. Dupilumab was recommended, with resolution of most of her cutaneous infection.

The Ethical Implications of Dermatology Residents Treating Attending Physicians.

Dermatology residents regularly will be faced with ethical conundrums during clinical practice. Resources have been developed to help residents navigate these scenarios in a thoughtful manner. Due to concerns for quality of care and discomfort for both the resident and attending, residents usually should not treat supervisory attending physicians. There are exceptions to this tenant, however, including emergencies and minor, self-limited concerns. This column will explore these topics, providing resources and a mental framework so further ethical situations can be examined.

Acne scarring-pathophysiology, diagnosis, prevention and education - Part 1.

Acne scarring is common and can occur despite effective acne management. Acne scarring patients suffer from significant psychosocial morbidity including depression and suicidality. Despite availability and advancement of therapeutic modalities, treatment for acne scarring is uncommon and often overlooked in the acne patient encounter. The utilization of acne scarring assessment tools and identification of specific acne scar subtypes allow for a tailored therapeutic approach. Part I of this continuing medical education series covers the pathophysiology and morphology of textural and pigmented acne scars, scarring assessment tools and medical treatment options. The principles reviewed will aid in the approach and initiation of acne scar treatment in the outpatient setting.

How Dermatology Residents Can Best Serve the Needs of the LGBT Community.

The lesbian, gay, bisexual, and transgender (LGBT) community is an underserved population that consists of approximately 5.6% of the population. Dermatologists may be an individual's only medical provider or, because of the clinically apparent and cosmetically sensitive nature of the field, may be able to provide the necessary care that allows a person to authentically express themselves. To provide the best care to members of this community, physicians should be familiar with current terminology and be comfortable delving into patient needs. Residents can spearhead practice changes to provide a comfortable environment for LGBT patients. Finally, being familiar with health problems that can be encountered within this community can prepare a dermatologist to provide paramount care.

Procedural and surgical treatment modalities for acne scarring - Part 2.

The optimal treatment of acne scarring is challenging because it involves consideration of several factors, including the type and number of scars, Fitzpatrick skin type, and the amount of downtime permissible to the patient. The second article in this CME series discusses the procedural treatments available for acne scarring, including the use of chemical peels, fillers, radiofrequency microneedling, lasers and surgical procedures. The indications for each modality, evidence for its benefits, and the adverse effects are discussed. This section aims to help guide the reader to select and implement the most appropriate treatment based on the patient's preferences, acne scar and skin type.

Feedback and Education in Dermatology Residency.

Feedback and education are the cornerstones to medical education. Residents can provide feedback and teach medical students and interns while both providing and receiving feedback from fellows and attending physicians. Although there is no correct method of feedback, when and how feedback is delivered can affect its effectiveness. Methods have been outlined to make feedback more meaningful and impactful, most of which are sourced from both published teaching methods and expert opinion. Feedback also is reciprocal, with all levels of providers giving feedback to each other to best improve the field of dermatology.

Diagnosis and treatment of low-risk superficial basal cell carcinoma in a single visit.

INTRODUCTION: Surgical excision remains the most commonly utilized treatment for superficial basal cell carcinoma (sBCC). In the era of cost containment of healthcare, the rising incidence of BCC and the high cost of excision require a continuous search for efficient and cost-effective management. OBJECTIVE: Examine the feasibility of the diagnosis and treatment of low-risk sBCC in a single visit. MATERIALS AND METHODS: Retrospective chart review of sBCCs diagnosed and treated in a single visit. RESULTS: The study identified 151 histologically confirmed sBCCs in 86 patients over a 5-year period, 93 (61.6%) cases of which were diagnosed as low-risk sBCC and treated in a single appointment. The majority of the cases (n = 86) were treated with curettage alone and the rest (n = 7) with a shave removal technique. The average size of the lesion was 0.82 cm located primarily on the trunk and extremities (95.7%). One recurrence on the trunk was observed in the single appointment group. Overall, diagnostic sensitivity was 95.4% and specificity was 92.0%. CONCLUSIONS: Diagnosis and treatment of sBCC in a single visit is an efficient and cost-effective management option for those who are proficient in identifying low-risk sBCC.

Congenital onychodysplasia of the ring finger presenting as a bifid nail.

Congenital onychodysplasia, or Iso-Kikuchi syndrome, is classically defined as a congenital nail abnormality of one or both index fingers that is often associated with a bone abnormality in the affected finger. We report an unusual case of a 6-year-old girl who presented with an S-shaped, bifid nail of the left ring finger that had been present since birth. X-ray findings were used to confirm a diagnosis of congenital onychodysplasia of the ring finger.

Purification of ADCs by Hydrophobic Interaction Chromatography.

Antibody-drug conjugate (ADC) in vitro potency has been shown to be dependent on drug load, with higher drug load providing lower IC50 values. However, in vivo potency is affected by intrinsic biological effects as well, such as plasma clearance, dose-limiting toxicity, etc. Developing a preparative HIC process for ADC purification to isolate species with a specific drug loading involves several steps including conjugation optimization, resin selection, solubility studies gradient screening, and step gradient development (buffer selection). In this chapter, the rationale and general considerations for developing a preparative hydrophobic interaction chromatography (HIC) method are described for isolation of an example ADC with specific drug load, e.g., two monomethyl auristatin E (MMAE) payloads (E2).

Cutaneous B-Cell Lymphoblastic Lymphoma.

B-cell lymphoblastic lymphoma (B-LBL) is a malignant neoplasm of immature B cells that accounts for only 10% of all cases of lymphoblastic lymphoma. Most commonly, B-LBL presents as bony lesions, but in rare cases, the disease manifests cutaneously. We present a case of simultaneous cutaneous and systemic presentation of B-LBL in an otherwise healthy 28-year-old man in which the lymphoblastic infiltrate stained positive for CD79a, Tdt, CD10, and CD20. A diagnosis of cutaneous B-LBL was made, and systemic work-up revealed widespread involvement of the skin, bone, and lymph nodes. Review of all currently described cases of cutaneous B-LBL with or without systemic involvement revealed that the most frequently positive tumor markers were CD79a (92.3%), Tdt (90.6%), and CD10 (83.3%). Systemic involvement of B-LBL was found in nearly half of all cases with cutaneous presentation.

Special Considerations in the Treatment of Mycosis Fungoides.

Mycosis fungoides is the most common form of cutaneous T cell lymphoma. Although normally presenting to physicians at an early stage and with an indolent course, mycosis fungoides can have a varied presentation. The National Comprehensive Cancer Network (NCCN) has created guidelines for the treatment and staging of mycosis fungoides. Although comprehensive, in practice these guidelines do not provide specific treatment regimens for lesions located in difficult locations and those recalcitrant to the recommended therapy. Because of this, suggestions based on the practices and decisions made at the multidisciplinary cutaneous lymphoma clinic at the Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA, are presented here. Lesions located in areas such as the face and intertriginous zones are often challenging to treat because first-line therapies are often inappropriate, with the locations increasing the possibility of side effects. Additionally, lesions located in the bathing suit distribution are often nonresponsive to first-line therapies for reasons still undetermined. Finally, although well-described, erythroderma secondary to mycosis fungoides is challenging to treat, with controversy surrounding various methods of control. This article both highlights difficult clinical scenarios and reviews the recommended treatment as provided by the NCCN guidelines and provides alternative therapy for lesions that are either difficult to treat because of the location or are recalcitrant to the recommended therapy. With suggestions for the apparent gaps in guidelines, providers can better treat patients who present with more complicated conditions.