Dermatologists' Perceptions of the Use of Teledermatology in Managing Hidradenitis Suppurativa: Survey Study.

BACKGROUND: The field of teledermatology has expanded tremendously and has been used for conditions including hidradenitis suppurativa (HS). However, due to the sensitive location of lesions, HS may be considered less suitable for teledermatology. OBJECTIVE: We sought to assess dermatologists' experiences and perceptions toward using teledermatology for HS relative to atopic dermatitis (AD) as a comparison. METHODS: A survey was disseminated electronically to practicing dermatologists in the Asia-Pacific region between February and June 2022. Differences in attitudes and perceptions between HS and AD were compared using random-effects ordered logistic regression, controlling for demographics. RESULTS: A total of 100 responses were obtained comprising of 76 (81.7%) dermatologists and 17 (18.3%) dermatology trainees; 62.6% (62/98) of physicians were uncomfortable with using teledermatology for HS. Multivariable regression confirmed increased perceived challenges with managing HS using teledermatology compared to AD. These challenges include the need for photography of hard-to-reach or sensitive areas (odds ratio [OR] 4.71, 95% CI 2.44-9.07; P<.001), difficulties in accurate assessment of severity (OR 2.66, 95%CI 1.48-4.79; P=.001), and inability to palpate lesions (OR 2.27, 95% CI 1.23-4.18; P=.009). CONCLUSIONS: This study confirms the relative reluctance of dermatologists to use teledermatology for HS and complements existing data showing mixed levels of willingness from patients. The use of teledermatology for HS may need to be optimized to overcome these challenges, including increasing security features, selection of patients with milder or limited diseases, and selecting patients with an established and strong doctor-patient relationship.

Porocarcinoma with orbital metastasis, a case report with review of literature.

We present a patient who presented with an orbital mass lesion which was a metastatic lesion from a porocarcinoma of the scalp with progressive deterioration of the patient.A 78-year-old male presented with functional decline and a rapidly growing scalp lesion of 3 months duration. In addition to the scalp lesion, Computed Tomography showed an incidental finding of a left lateral orbital wall tumour. Fine-needle aspiration of the two lesions revealed malignant cells with similar morphologies. Punch biopsy of the scalp lesion showed histological features suggestive of a porocarcinoma. Patient underwent palliative radiotherapy and immunotherapy and subsequently succumbed to the disease.

Knowledge, attitudes, and perceptions of hidradenitis suppurativa among young adults in Singapore.

Background: The prevalence of hidradenitis suppurativa (HS) is 0.00033% to 4.10% globally. Few epidemiological studies derive from Asia, with social stigmatization postulated to result in under-diagnosis. Objective: This study aimed to assess the self-reported prevalence of HS, and the knowledge, attitudes, and perceptions towards HS among Singaporean young-adults. Methods: A cross-sectional study (n = 158) was conducted by anonymous online questionnaire. The association between demographic factors and risk of potentially undiagnosed HS was evaluated using multivariable logistic regression. Differences between attitude-perception scores by demographic factors and knowledge of HS were tested using two-sample t-tests. Results: The prevalence of diagnosed and potentially undiagnosed HS was 0.63% and 8.9%, respectively. Non-Chinese had significantly higher social attitude-perception scores than Chinese (P = .029). Females had significantly higher social (P = .048) as well as economic and work (P = .037) attitude-perception scores than males. Those with knowledge of HS had significantly higher attitude-perception scores for interpersonal (P = .031) and social (P = .0052) subsections. Limitations: Small sample size, low frequency of HS cases, and self-reported prevalence may not generalize to the broader population in Singapore. Conclusion: Our results suggest a potential underdiagnosis of HS. Non-Chinese stigmatize HS less than Chinese, and females less than males. Individuals with knowledge of HS might be more open to interpersonal and social interactions with HS sufferers.

In situ and self-adaptive BOD bioreaction sensing system based on environmentally domesticated microbial populations.

Biochemical oxygen demand (BOD) is a water quality parameter of vital importance. Rapid BOD analysis methods have emerged to simplify the five-day BOD (BOD5) measurement protocol. However, their universal implementations are restricted by the tricky environmental matrix (including environmental microbes, contaminants, ionic compositions, etc.). Here, an in situ and self-adaptive BOD bioreaction sensing system consisting of a "gut-like" microfluidic coil bioreactor with self-renewed biofilm was proposed for the establishment of a rapid, resilient and reliable BOD determination method. With the spontaneous surface adhesion of environmental microbial populations, the biofilm was colonized in situ on the inner surface of the microfluidic coil bioreactor. Exploiting the environmental domestication during every real sample measurement, the biofilm was capable of self-renewal to adapt to the environmental changes and exhibited representative biodegradation behaviors. The aggregated abundant, adequate and adapted microbial populations in the BOD bioreactor rendered a total organic carbon (TOC) removal rate of 67.7% within a short hydraulic retention time of 99 s. As validated by an online BOD prototype, exceptional analytical performance was achieved in terms of reproducibility (relative standard deviation of 3.7%), survivability (inhibition by pH and metal ion interference of <20%) and accuracy (relative error of -5.9% to 9.7%). This work rediscovered the interactive effects of the environmental matrix on BOD assays and demonstrated an instructive attempt by making use of the environment to develop practical online BOD monitoring devices for water quality assessments.

Malignancy-associated generalised exfoliative dermatitis: A retrospective study in a single-centre Asian cohort.

BACKGROUND: Erythroderma is an inflammatory skin condition that causes extensive erythema and skin scaling amounting ≥90% of the body surface area. This retrospective cohort study describes the prevalence of malignancy-associated erythroderma in a single centre where there was concerted effort to systematically offer malignancy screens to all adult erythroderma patients above the age of 65 years. METHODS: Clinical charts were reviewed for all adult inpatients and outpatients with erythroderma who attended the National University Hospital (NUH) from 1 July 2019 to 31 December 2021. Data collected included patient demographics, clinical findings, laboratory investigations, disease-specific investigations such as endoscopic procedures and biopsies, follow-up duration and mortality data. RESULTS: Seventy-four patients were analysed. The median age of the patients was 73 years old (interquartile range: 59-81 years old). An underlying dermatosis was the most common cause of erythroderma-63 patients having atopic dermatitis/asteatotic eczema or psoriasis. Three patients had erythroderma from drug eruptions, and 1 patient had chronic actinic dermatitis. Four patients had associated malignancies (5.4%). Half of our patients completed further evaluation for malignancy (52.7%). The rest had either declined or were eventually unable to complete the investigations. There was a higher prevalence of associated malignancy (7.8%) in elderly patients above 65 years old. CONCLUSION: When compared to existing literature, our cohort reflects a higher observed occurrence of malignancy in association with erythroderma. As delays in evaluation for underlying malignancy could result in potentially deleterious outcomes, it is prudent to consider systematic screening for malignancy in high-risk populations such as elderly erythroderma patients.

A Universal Biofilm Reactor Sensor for the Determination of Biochemical Oxygen Demand of Different Water Areas.

In this study, we developed a simple strategy to prepare a biofilm reactor (BFR) sensor for the universal biochemical oxygen demand (BOD) determination. The microorganisms in fresh water were domesticated by artificial seawater with different salinity gradients successively to prepare the BFR sensor. The prepared BFR sensor exhibits an efficient ability to degrade a variety of organic substances. The linear range of BOD determination by the BFR sensor is 1.0-10.0 mg/L-1 with a correlation coefficient of 0.9951. The detection limit is 0.30 mg/L according to three times of signal-to-noise ratio. What is more, the BFR sensor displayed excellent performances for the BOD determination of different water samples, including both fresh water and seawater. The 16S-rRNA gene sequencing technology was used to analyze the microbial species before and after the domestication. The results show that it is a general approach for the rapid BOD determination in different water samples.

Significant loss of soil inorganic carbon at the continental scale.

Widespread soil acidification due to atmospheric acid deposition and agricultural fertilization may greatly accelerate soil carbonate dissolution and CO2 release. However, to date, few studies have addressed these processes. Here, we use meta-analysis and nationwide-survey datasets to investigate changes in soil inorganic carbon (SIC) stocks in China. We observe an overall decrease in SIC stocks in topsoil (0-30 cm) (11.33 g C m-2 yr-1) from the 1980s to the 2010s. Total SIC stocks have decreased by ∼8.99 ± 2.24% (1.37 ± 0.37 Pg C). The average SIC losses across China (0.046 Pg C yr-1) and in cropland (0.016 Pg C yr-1) account for ∼17.6%-24.0% of the terrestrial C sink and 57.1% of the soil organic carbon sink in cropland, respectively. Nitrogen deposition and climate change have profound influences on SIC cycling. We estimate that ∼19.12%-19.47% of SIC stocks will be further lost by 2100. The consumption of SIC may offset a large portion of global efforts aimed at ecosystem carbon sequestration, which emphasizes the importance of achieving a better understanding of the indirect coupling mechanisms of nitrogen and carbon cycling and of effective countermeasures to minimize SIC loss.

Factors influencing use and perceptions of teledermatology: A mixed-methods study of 942 participants.

BACKGROUND: The protracted COVID-19 pandemic highlights the need for a sustainable telemedicine practice. OBJECTIVE: To understand patient perceptions toward teledermatology. METHODS: Convergent parallel mixed-methods study of 942 dermatology patients or their caregivers between June 2020 and April 2021. RESULTS: Multivariate regression found that youth, increased computer use, willingness to show body areas over photo/video, perceived quality of teledermatology, demand for social distancing and to reduce commute were associated with willingness to use teledermatology. The willingness to use teledermatology declined with the easing of COVID-19 movement restrictions, and 48.5% reported a poorer experience with teledermatology than with in-person consultations. Qualitative data from 26 interviews showed that willingness to use is influenced by pragmatic considerations, emotional factors, and data privacy concerns. These were moderated by the patient's perception of disease severity and need for an accurate diagnosis. LIMITATIONS: Lack of data prior to the pandemic and during the initial lockdown period. CONCLUSION: The willingness to use teledermatology is influenced by circumstantial factors, technology literacy, views toward teledermatology, and factors driving the purpose of consultation. The declining willingness to use teledermatology with the easing pandemic, lower willingness to pay full in-clinic prices, and poorer experience compared with in-person consultations highlights the need to optimize this mode of delivery.

Changes in the profile properties and chemical weathering characteristics of cultivated soils affected by anthropic activities.

The study of the pedogenic process in response to natural evolution, gradual anthropogenic shifts and engineering upheavals is of great significance for understanding, utilizing and transforming nature in the future. Although scholars have considered anthropic activities to be an important factor affecting pedogenesis, research on how and how much anthropic activities influence the soil-forming process is scant. This paper was conducted to analyse pedogenic characteristics dominated by anthropic activities. In this study, the parent materials and soils undergoing natural evolution (NE), tillage perturbation (TP) and engineering perturbation (EP) were selected as research objects. The genetic characteristics of soils undergoing NE, TP and EP are investigated mainly from three aspects: soil profile macromorphological characteristics, soil physical and chemical properties and chemical weathering characteristics. The results indicated that the influence of anthropic activities (TP and EP) on the process of pedogenesis is complicated. First, compared with NE, TP decreases the thickness of topsoil from 22.2 to 21.2 cm, while EP increases the thickness of topsoil from 22.2 to 23.2 cm, and EP causes the soil to have a high profile development index. Second, compared with TP, EP can improve bulk density (BD), soil organic carbon (SOC), total nitrogen (TN) and cation exchange capacity (CEC), Finally, the chemical weathering intensity differed among NE, TP and EP and followed the order of TP > NE > EP. Therefore, in the future, the genetic characteristics of soils dominated by anthropic activities should be considered. This will help us systematically understand the genesis and evolutionary characteristics of soil and lay a foundation for further perfecting the diagnostic horizon and diagnostic characteristics of the Soil Taxonomy and World Reference Base.

Steroid Phobia: Is There a Basis? A Review of Topical Steroid Safety, Addiction and Withdrawal.

There is a growing concern amongst patients about topical corticosteroid (TCS) side effects, with increasing discussion of topical steroid addiction (TSA) and topical steroid withdrawal (TSW) particularly on social media platforms. However, the acceptance of TSA/TSW as a distinct condition remains controversial within the dermatological community. We conducted a literature search using PubMed, MEDLINE, Cochrane Library, Google Scholar, Embase and Web of Science to identify original articles addressing TSA/TSW. We described the definition and reported clinical features of TSA/TSW including its classification into erythemato-edematous and papulopustular subtype. To assess the validity of TSA/TSW, we summarised and objectively appraised the postulated mechanisms for this condition, including tachyphylaxis, dysregulation of glucocorticoid receptors, rebound vasodilation and impaired skin barrier leading to a cytokine cascade. Understanding the evidence including its limitations and uncertainties highlights areas for future research and helps medical practitioners better counsel and provide care to patients who may be experiencing or who have concerns about TSA/TSW.

Supportive oncodermatology-a narrative review of its utility and the way forward.

Supportive oncodermatology is an interdisciplinary field, emerging due to increasing dermatological morbidity in patients with cancer and the recognition of the need for greater collaborative and integrated care to improve patient outcomes. These two unique fields (Oncology and Dermatology) may be integrated in various ways, such as through specialised combined clinics, protocols for expedited access, multidisciplinary groups and meetings, and the development of best practices guidelines. This narrative review consolidates the small but growing literature surrounding supportive oncodermatology; discusses the potential benefit and disadvantages, and areas for future research; and suggests a framework for implementation.

[Effect of Fertilizer Reduction and Biochar Application on Soil Nitrogen Loss in Purple Upland].

This study seeks to clarify the effect of biochar application on nitrogen loss patterns and flux in purple arid sloping land, so as to provide a scientific basis for improving the quality of farmland and reducing the risk of agricultural non-point source pollution in purple arid sloping land. The effects of four treatments on surface runoff and soil nitrogen loss patterns and fluxes in purple arid sloping land were studied by field experiments, including no fertilization (control), conventional fertilization, optimized fertilization, and biochar (fertilizer reduction and biochar application). The results showed that:① Of the fertilization treatments, the total runoff of conventional treatment was the highest at 16133 L·a-1, and the total runoff of biochar treatment was the lowest at 11893 L·a-1. In each fertilization treatment, soil midstream was the main mode of runoff, accounting for 61.80%-68.60% of the total loss. Compared with the control (no fertilization treatment), the sediment loss in other fertilization treatments was decreased, with conventional treatment showing the most significant effect. ② Ammonium nitrogen is mainly lost by surface runoff, accounting for 86.51%-96.58% of the total loss flux. Biochar treatment had the highest loss flux at 0.69 kg·(hm2·a)-1, and the control treatment had the lowest at 0.17 kg·(hm2·a)-1. ③ The concentration of granular nitrogen in the production flow of each fertilization treatment was higher than that of the control treatment, and the loss flux of granular nitrogen in the conventional fertilization treatment was the highest at 2.87 kg·(hm2·a)-1. ④ There was a significant positive correlation between total nitrogen concentration and nitrate nitrogen concentration in the soil midstream and surface runoff of each fertilization treatment (P<0.01). Nitrate nitrogen is the main form of total nitrogen loss, and both take soil midstream as the main way of loss. The total nitrogen loss through soil flow accounted for 72.86%-89.13%, and that of conventional fertilization was the highest at 35.58 kg·(hm2·a)-1, whereas that of biochar treatment was the lowest at 21.49 kg·(hm2·a)-1. Reducing the amount of fertilizer and applying biochar can significantly reduce the runoff and nitrogen flux, and effectively prevent and control the risk of agricultural non-point source pollution.