Severe complication after microwave thermoablation of a residual limb: multifocal full thickness cutaneous necrosis and deep venous thrombosis.

Patients with limb loss face the challenge of having an increased risk of skin disease at residual limb sites. Hyperhidrosis is a common concern for persons with amputation and excessive sweat can cause various skin pathology. Recently, microwave thermoablation (MT) was reported as an effective off-label treatment for hyperhidrosis in patients with limb loss. We present a case in which a patient following MT procedure for hyperhidrosis of a transtibial amputation developed multifocal full thickness cutaneous necrosis and deep venous thrombosis. The possible aetiologies of these complications are discussed including vascular congestion and external thermal injury.Such a case warrants the attention of individuals and providers seeking to use MT for off-label purposes, particularly for patients with limb loss, due to the large treatment surface area and potential for temporary or permanent functional loss of the amputated limb.

Sarcoidosis in Post-9/11 Military Veterans.

Historically, US servicemembers have faced unique environmental hazards that may increase their risk for developing sarcoidosis. Cutaneous sarcoidosis is the most common extrapulmonary manifestation of sarcoidosis and can precede systemic manifestations of the disease. In this article, we review the literature to examine the risk factors and incidence of sarcoidosis in post-9/11 veterans as well as provide recommendations for workup and management. Importantly, we also highlight that sarcoidosis is a presumptive diagnosis under the recently enacted Promise to Address Comprehensive Toxics (PACT) Act and may be service connected. Veterans with sarcoidosis should be referred to the US Department of Veterans Affairs.

Ischemic alopecia as a complication from therapeutic embolization of the middle meningeal artery.

Selective endovascular embolization using microspheres is a widely used, relatively low-risk procedure to control intracranial bleeding. Side effects such as cranial nerve palsies and stroke have been reported in the literature. Skin necrosis and alopecia are exceedingly rare complications of endovascular embolization with a reported incidence of less than 1%. We report a case of a 55-year-old female who developed alopecia following a therapeutic embolization of the middle meningeal artery using microspheres. The clinical-histopathologic diagnosis and relevant literature are reviewed.

Long-term Effectiveness of Microwave Thermoablation in Persons With Residual Limb Hyperhidrosis: A Case Series.

Excessive sweating or focal hyperhidrosis (HH) of the residual limb in persons with amputations is thought to be a significant contributor to residual limb dermatoses, prosthesis dysfunction, and decreased quality of life. Treatment algorithms used for HH in persons without amputation do not effectively translate to residual limb HH, and research in this area is sparse. We discuss the long-term outcomes of three patients treated with microwave thermoablation (MT) on their residual limbs who had previously been unsuccessfully managed with topical antiperspirants and botulinum toxin injections. On average, there was a decrease of two points in the Hyperhidrosis Severity Scale score among the three patients 4-6 years after treatment. Although the reported side effects of post-procedure edema and prolonged time out of a prosthesis are challenging, MT of the residual limb appears to be a promising treatment modality for persons with amputation. Further investigations for standardized treatment guidelines are required to improve management of residual limb HH with MT.

Treatment and Current Policies on Pseudofolliculitis Barbae in the US Military.

Pseudofolliculitis barbae (PFB), or ingrown hairs, is a common skin condition of the face and neck caused by shaving in predisposed individuals who have naturally curly hair. It uniquely affects a disproportionate number of US service members with African ancestry who must abide by strict uniform grooming standards across the entire military. The main rationale behind this policy is that a beard can prevent a proper seal when using breathing protection devices such as gas masks or N95 respirators. Against the backdrop of the COVID-19 pandemic and ever-looming overseas conflicts, dermatologists who treat service members should be aware of the separate yet related guidelines to treat PFB that each military branch follows. Herein, we review the treatments and current policies on PFB in the US Military.

Developing and Measuring Effectiveness of a Distance Learning Dermatology Course: A Prospective Observational Study.

As a response to the COVID-19 pandemic, many institutions transitioned to online learning or participation in telehealth as a substitute for clinical rotations. The Uniformed Services University of the Health Sciences (Bethesda, Maryland) relied heavily on e-learning during this time as an alternative means for meeting educational objectives. We report the positive results of a prospective study evaluating short-term information recall and comprehension as well as students' confidence in their ability to apply course objectives over 3 months of an online distance learning (DL) dermatology course.

Hyperhidrosis of the residual limb: a narrative review of the measurement and treatment of excess perspiration affecting individuals with amputation.

BACKGROUND: Hyperhidrosis (HH) is a relatively common disorder involving excessive sweating, typically of the palms or axilla. HH can also frequently occur after limb amputation, where the remaining residual limb excessively perspires, leading to an increased risk of dermatological disorders and functional limitations, such as the inability to comfortably or safely wear a prosthesis. Although many treatments have been proposed to treat HH within the dermatology community, they are not widely known by healthcare providers typically involved in caring for individuals with acquired limb loss. OBJECTIVES: To appraise the current state of quantitative and qualitative assessment of HH within the residual limb and examine existing and future treatment strategies for this problem. STUDY DESIGN: Narrative Literature Review. METHODS: A literature review focused on the assessment and treatment of excessive sweating of residual limbs. RESULTS: There is currently no objective or subjective standard to assess or diagnose HH of the residual limb. Conventional therapies for HH do not always translate to the population of individuals with limb loss. Emerging modalities for treating HH show promise toward a permanent resolution of excess perspiration but require additional studies within people with amputation. CONCLUSIONS: Further research is needed to quantify standard values to objectively and subjectively assess and diagnose hyperhidrosis of the residual limb. New and developing treatments for hyperhidrosis require additional studies to assess efficacy and safety in the residual limb.

The dermatologist's role in amputee skin care.

Amputees face many challenges associated with residual limbs. Overall, amputees have an increased risk for skin disease occurring at residual limb sites. Although prosthetists and primary care physicians often accomplish routine care, the dermatologist plays a very important role within the multidisciplinary team. Many military dermatologists have unique clinical experience treating amputees, as a portion of their practice consists of providing care to soldiers with traumatic amputations from complex and dramatic blast injuries. Although current therapies and preventative treatments are for the most part successful, future research involving advanced technology is promising.

Evaluation of Virulence Gene Expression Patterns in Acinetobacter baumannii Using Quantitative Real-Time Polymerase Chain Reaction Array.

According to the Centers for Disease Control's recently devised National Strategy for Combating Antibiotic-Resistant Bacteria, Acinetobacter baumannii is a "serious" threat level pathogen. A. baumannii's notoriety stems from the fact that a large number of modern strains are multidrug resistant and persist in the hospital setting, thus causing numerous deaths per year. It is imperative that research focus on a more fundamental understanding of the factors responsible for the success of A. baumannii. Toward this end, our group investigated virulence gene expression patterns in a recently characterized wound isolate, AB5075, using quantitative real-time polymerase chain reaction array. Notably, several genes showed statistically significant upregulation at 37°C compared to 25°C; MviM, Wbbj, CarO, and certain genes of the Bas, Bar, and Csu operons. Additionally, we found that in vitro biofilm formation by Csu transposon insertion mutant strains is attenuated. These findings validate previous reports that suggest a link between the Csu operon and biofilm formation. More importantly, our results demonstrate a successful method for evaluating the significance of previously identified virulence factors in a modern and clinically relevant strain of A. baumannii, thereby providing a path toward a more fundamental understanding of the pathogenicity of A. baumannii.

Human telomere sequence DNA in water-free and high-viscosity solvents: G-quadruplex folding governed by Kramers rate theory.

Structures formed by human telomere sequence (HTS) DNA are of interest due to the implication of telomeres in the aging process and cancer. We present studies of HTS DNA folding in an anhydrous, high viscosity deep eutectic solvent (DES) comprised of choline choride and urea. In this solvent, the HTS DNA forms a G-quadruplex with the parallel-stranded ("propeller") fold, consistent with observations that reduced water activity favors the parallel fold, whereas alternative folds are favored at high water activity. Surprisingly, adoption of the parallel structure by HTS DNA in the DES, after thermal denaturation and quick cooling to room temperature, requires several months, as opposed to less than 2 min in an aqueous solution. This extended folding time in the DES is, in part, due to HTS DNA becoming kinetically trapped in a folded state that is apparently not accessed in lower viscosity solvents. A comparison of times required for the G-quadruplex to convert from its aqueous-preferred folded state to its parallel fold also reveals a dependence on solvent viscosity that is consistent with Kramers rate theory, which predicts that diffusion-controlled transitions will slow proportionally with solvent friction. These results provide an enhanced view of a G-quadruplex folding funnel and highlight the necessity to consider solvent viscosity in studies of G-quadruplex formation in vitro and in vivo. Additionally, the solvents and analyses presented here should prove valuable for understanding the folding of many other nucleic acids and potentially have applications in DNA-based nanotechnology where time-dependent structures are desired.