Single-Centre Retrospective Audit of Clostridium difficile Infections Post Ileostomy Reversal.

Background Clostridium difficile (C. difficile) infection can have serious implications on patient outcomes, especially post ileostomy reversal. The symptoms can range from asymptomatic/mild to severe, with significant morbidity or mortality. Thus far, no study has been published to determine the role and impact of preoperative C. difficile testing prior to ileostomy reversal. The aim of this audit was to identify risk factors for the development of post-ileostomy reversal C. difficile infection and provide further improvements and direction for future research. Methods All patients undergoing ileostomy reversal at the General Surgery Department at Sir Charles Gairdner Hospital, a tertiary centre in Perth, Western Australia, were retrospectively identified between January 2019 and June 2021. Demographics and key data points, such as specific types of antibiotic usage, were extracted from patient notes and analysed using IBM SPSS Statistics for Windows, version 27 (released 2020; IBM Corp., Armonk, New York, United States). Results Sixty-nine patients were identified in the audit period, with 8.70% of patients testing positive for C. difficile infection post ileostomy reversal. At the index ileostomy formation operation, postoperative use of quinolone antibiotics was statistically associated with an increased risk of developing C. difficile on ileostomy reversal (odds ratio (OR) = 15.25, confidence interval (CI) 95%, p = 0.035). Intraoperative nitroimidazole use was statistically associated with a reduced risk of C. difficile infection on ileostomy reversal (OR = 0.16, CI 95%, p = 0.045). Patients who had diverticulitis as their underlying disease pathology were 10 times more likely to develop C. difficile infection post ileostomy reversal, although this finding was not statistically significant in our study. Conclusion Several risk factors were identified, such as the use of quinolone antibiotics or having underlying diverticulitis as causes for ileostomy formation. The results from this audit provides further direction in designing further research studies into the role and impact of C. difficile testing and treatment in the perioperative period around ileostomy reversal.

A Systematic Review on the Clinical Pharmacokinetics of Cephalexin in Healthy and Diseased Populations.

Cephalexin is a first-generation ß-lactam antibiotic used in adults and pediatrics to treat various streptococcal and staphylococcal infections. This review aims to summarize and evaluate all the pharmacokinetic (PK) data on cephalexin by screening out all pertinent studies in human beings following the per oral (PO) route. By employing different online search engines such as Google Scholar, PubMed, Cochrane Central, and Science Direct, 23 studies were retrieved, among which nine were in healthy subjects, five in diseased ones, and the remaining were drug-drug, drug-food, and bioequivalence-related. These studies were included only based on the presence of plasma concentration-time profiles or PK parameters, i.e., maximum plasma concentration (Cmax), half-life (t1/2) area under the curve from time 0-infinity (AUC0-∞), and clearance (CL/F). A dose-proportional increase in AUC0-∞ and Cmax can be portrayed in different studies conducted in the healthy population. In comparison to cefaclor, Cmax was recorded to be 0.5 folds higher for cephalexin in the case of renal impairment. An increase in AUC0-∞ was seen in cephalexin on administration with probenecid, i.e., 117 µg.h/mL vs. 68.1 µg.h/mL. Moreover, drug-drug interactions with omeprazole, ranitidine, zinc sulfate, and drug-food interactions for cephalexin and other cephalosporins have also been depicted in different studies with significant changes in all PK parameters. This current review has reported all accessible studies containing PK variables in healthy and diseased populations (renal, dental, and osteoarticular infections, continuous ambulatory peritoneal dialysis) that may be favorable for health practitioners in optimizing doses among the latter.

Prevalence of Migraine Headache in Saudi Arabia: A Systematic Review and Meta-Analysis.

BACKGROUND: Migraine is an important healthcare concern that silently affects diverse populations globally. The rising prevalence of migraine affects the quality of life of individuals, the economic burden of a nation, and work productivity. This study was designed to determine the prevalence of migraine in Saudi Arabia. METHODOLOGY: A systematic data search was designed, and scientific data were collected from leading databases, including PubMed, The Cochrane Library, Web of Science, Ovid, and Google Scholar. RESULTS: Thirty-six studies, comprising 55061 study participants based on defined inclusion criteria, were statistically analyzed using StatsDirect software. The pooled proportion of migraine in Saudi Arabia among all 36 selected studies was 0.225617 (95% confidence interval (CI) = 0.172749 to 0.28326). The study was grouped into four categories: general population, students (of both genders), studies based on females only, and healthcare professionals in primary health care (PHC). The migraine pooled proportion among all four groups using random effects (DerSimonian-Laird) was 0.213822 (95% CI = 0.142888 to 0.294523), 0.205943 (95% CI = 0.127752 to 0.297076), 0.345967 (95% CI = 0.135996 to 0.593799), and 0.167068 (95% CI = 0.096429 to 0.252075), respectively. CONCLUSION: The estimated pooled proportion of migraine in Saudi Arabia is 0.225617, which is comparable to or even higher than other parts of the Middle East region. Migraine has a great impact on quality of life, productivity, and economic capacity, and increases the healthcare burden. Early detection and necessary lifestyle measures are necessary to minimize this number.

Benefits and challenges of fostering research-focused communities of practice at a specialised health sciences university: An exploratory study.

Introduction: Structured undergraduate research, whether mandatory or elective, provides undergraduate students with a unique opportunity to develop their research skills. However, the majority of the students undertake individual research projects rather than working in a group. This study explores the perceived benefits and challenges of fostering research focused communities of practice at a specialised health sciences university in Riyadh, Saudi Arabia. Methods: This cross-sectional study was conducted at the College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) Riyadh, Saudi Arabia. The study was approved by the Ethics Committee at the King Abdullah International Medical Research Center (KAIMRC). A self-administered questionnaire was developed that assessed the perceived benefits and challenges of doing research in groups. Data were collected using a mixture of a dichotomous and a 5-point Likert scale and were analysed using Statistical Program for Social Scientists (SPSS). Results: Of the 380 medical students invited to participate in this study, 307 completed the questionnaire, with a response rate of 80.7%. The majority of the medical students (87%) agreed on the importance of teamwork in conducting medical research. Almost all medical students (96%) believed patience and tolerance were required to make the team successful. Significant differences were found between junior and senior medical students regarding their perceived benefits (P-value = 0.0001) and challenges (P-value = 0.0007). Conclusion: Although most of the students believed that doing research in groups is essential and that working within such groups enhances their research knowledge, forming these research groups was not without problems. The need for patience and tolerance to keep the group together, the issue of free-riders and the difficulties related to which research group to join were some of the challenges students encountered.

Rheumatoid Vasculitis, an Uncommon Complication of Non-Deforming Rheumatoid Arthritis: A Case Report.

We present an 18-year-old female from South Sudan presented with right fingertips ulceration and black discolouration associated with bilateral wrist/metacarpophalangeal joints pain for five months. The ulceration began at the tip of the right middle finger and gradually progressed to involve the rest of the hand and was associated with agonizing pain. A Doppler study of the right upper limb revealed thrombosis of the antecubital portion of the basilar, ulnar, and part of the distal radial arteries. Blood investigations showed high anti-CCP, doubtful rheumatoid factor titre and ANA titre of 1:320 with coarse and nucleated cells; however, all ANA parameters were negative. A definitive diagnosis of rheumatoid arthritis complicated by rheumatoid vasculitis was made. Unfortunately, the middle finger could not be preserved and ended up amputated, and the patient was commenced on steroids, DMARDs and warfarin. The patient responded very well to the management plan with pain alleviation, ulcers healing and clot resolution.

Influence of COVID-19 Protocols on the Efficiency of Trauma Theater: Retrospective Observational Study.

BACKGROUND: The COVID-19 pandemic has influenced health care delivery significantly. Numerous studies have highlighted that trauma theater efficiency has decreased during the COVID-19 pandemic; however, there is limited information as to exactly which stage of the patient theater journey is causing this decreased efficiency and whether efficiency can be improved. In the trauma theater of Warrington Hospital, United Kingdom, we have attempted to maintain trauma theater efficiency despite the requirement for increased infection control. OBJECTIVE: The aim of this study was to evaluate the effects of additional COVID-19 infection control protocols on trauma theater efficiency in our center, considering the length of time taken for specific theater events, and to find out whether our interventions were successful in maintaining theater efficiency. METHODS: We compared the efficiency of the trauma theater in a busy unit in December 2019 (pre-COVID-19) and December 2020 (with COVID-19 protocols in place). We collected time logs for different theater events for each patient in December of both years and compared the data. RESULTS: There was no significant difference in the average number of cases performed per session between the COVID-19 and pre-COVID-19 time periods (P=.17). Theater start time was significantly earlier during the COVID-19 period (P<.001). There was no significant difference between the two periods in transport time, check-in time, preprocedure time, anesthetic time, and the time between cases (P>.05). A significant difference was observed in the check-out time between the two groups in the two time periods, with checking out taking longer during the COVID-19 period (P<.001). CONCLUSIONS: Our results show that our theater start times were earlier during the COVID-19 pandemic, and the overall theater efficiency was maintained despite the additional COVID-19 infection control protocols that were in place. These findings suggest that well-planned infection control protocols do not need to impede trauma theater efficiency in certain settings.

Pollution characteristics, risk assessment, and source apportionment of potentially toxic elements in road dust at two industrial parks in Trinidad and Tobago, West Indies.

Potentially toxic elements can enter the environment through natural and anthropogenic processes, with the latter considered the primary contributor. Road dust samples from two industrial parks on the island of Trinidad were investigated for heavy metal content, and the pollution status, potential health risks, and source apportionment were evaluated. Samples were acid-digested and analysed by flame atomic absorption spectroscopy. The average levels of cadmium, chromium, copper, manganese, nickel, lead, and zinc in road dust at the Frederick Settlement Industrial Park were 1.14 µg/g, 15.13 µg/g, 66.42 µg/g, 768.49 µg/g, 37.95 µg/g, 55.90 µg/g, and 573.04 µg/g, respectively, while average concentrations at the O'Meara Industrial Park were 1.20 µg/g, 16.97 µg/g, 42.72 µg/g, 482.65 µg/g, 21.12 µg/g, 136.77 µg/g, and 358.70 µg/g, respectively. Contamination assessments evaluated both Fredrick Settlement and O'Meara as typically uncontaminated to moderately polluted, with the overall ecological risk deemed low at all locations. Hazard index values at all sampling areas were lower than 1, indicating no potential non-carcinogenic risks to children or adults, while the carcinogenic exposure risks for cadmium, chromium, and nickel were considered low. Principal component analysis and cluster analysis revealed two main sources of contamination for Fredrick Settlement, and three main sources for O'Meara. Based on the groupings obtained, the presence of potentially toxic elements was attributed primarily to specific anthropogenic activities within the industrial parks, with lesser contributions from vehicular-related sources.

Overt hepatic encephalopathy is an independent risk factor for de novo infection in cirrhotic patients with acute decompensation.

BACKGROUND: The occurrence of overt hepatic encephalopathy (OHE) is associated with increased mortality. HE is commonly precipitated by infection, but whether HE predisposes to new infection is unclear. This study aimed to test if OHE predisposes to de novo infection during hospitalisation and its association with short-term mortality. AIMS AND METHODS: Seven hundred and fifty-nine consecutive patients were identified at two institutions from prospectively maintained clinical databases of cirrhotic patients admitted with acute decompensation (AD). Infection and HE data were collected on the day of admission, and the occurrence of de novo infections was assessed for 28 days after admission. EASL-CLIF organ failure criteria were used to determine the presence of organ failures. Multivariable analysis using the logistic regression model was used to assess predictors of 28-day mortality and de novo infection. RESULTS: Patients were divided into four groups; no baseline OHE or infection (n = 352); OHE with no baseline Infection (n = 221); no OHE but baseline infection (n = 100) and OHE with baseline infection (n = 86). On multivariate analyses, OHE (OR, 1.532 [95% CI, 1.061-2.300, P = 0.024]), and admission to ITU (OR, 2.303 [95% CI, 1.508-3.517, P < 0.001]) were independent risk factors for de novo infection. 28-day mortality was 25.3%, 60.2%, 55.0% and 72.1% in the 4-groups respectively. Age, INR and creatinine were independently predictive of mortality. The presence of overt HE, infection, coagulation, kidney, circulatory, respiratory and liver failures were significantly associated with higher mortality. CONCLUSION: OHE is an independent risk factor for de novo infection in cirrhotic patients with AD.

Quantification and health risk assessment of heavy metals in residual floor dust at an indoor firing range: A case study in Trinidad, WI.

Residual floor dust at an indoor firing range was investigated for the presence of selected heavy metals, and the associated health risks (non-carcinogenic and carcinogenic) were explored. Average heavy metal concentrations decreased in the following order: Pb >> Cu >> Zn > Mn > Cr > Ni > Cd. For the examined floor dust, moderate to significant degrees of enrichment were observed for Ni, Cd, Cr and Zn while extremely high degrees of enrichment were reported for Cu and Pb. Lead was the only heavy metal that exceeded the Hazard Index value of 1 and the potential carcinogenic risks for Cd and Ni were considered acceptable. A potential carcinogenic risk existed for Cr, as denoted by a total lifetime cancer risk value greater than 10-4.

Downregulation of interleukin 36γ and its cleaver cathepsin G following treatment with narrow-band ultraviolet B phototherapy in psoriasis vulgaris.

BACKGROUND: Growing evidence suggests the important role of IL-36 in the pathogenesis of psoriasis. Cathepsin G is a neutrophil-derived protease that can activate IL-36γ. OBJECTIVE: To assess the expression of IL-36γ and cathepsin G in psoriasis and to quantify the impact of treatment with narrow-band ultraviolet B phototherapy (NB-UVB) on their levels. METHODS: This case-control study involved 26 patients with moderate-severe psoriasis and 25 healthy volunteers. Psoriasis patients eligible for phototherapy received 24 NB-UVB sessions. Punch skin biopsies were obtained from all participants at recruitment and after phototherapy from patients. Real-time PCR was utilized for quantitative assessment of IL-36γ and cathepsin G expression in tissue samples. RESULTS: The expression of IL-36γ and cathepsin G was significantly higher in psoriasis before NB-UVB therapy compared to controls (p < .001). Both proteins decreased significantly with clinical improvement following NB-UVB therapy compared to baseline (p < .001). However, their expression after treatment was still higher than controls (p < .001). CONCLUSION: IL-36γ and cathepsin G expression is upregulated in psoriatic lesions, supporting their role as mediators of inflammation in psoriasis. Downregulation of IL-36γ and cathepsin G is a possible mechanism for psoriasis improvement after NB-UVB therapy. IL-36 and cathepsin G can be considered as therapeutic targets for psoriasis.

Migraine Prevalence, Characteristics, Triggers, and Coping Strategies Among Medical Students in Saudi Arabia.

Objective: To determine the prevalence, characteristics, and triggers of migraine and coping strategies used among medical students in Saudi Arabia.Methods: This cross-sectional descriptive study was conducted among undergraduate students in the College of Medicine of Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. Included students were in their second to sixth academic year of the Bachelor of Medicine or Bachelor of Surgery programs during the 2019-2020 academic year. The diagnosis of migraine was made according to the International Classification of Headache Disorders, Third Edition criteria.Results: A total of 396 students participated in the study; 238 (60.1%) were female and 158 (39.9%) were male. Their age ranged between 18 and 26 years old, with a mean age of 21.32 ± 1.659 years. Only 16 of 396 students fulfilled the criteria for migraine, with a prevalence of 4.04%. Migraine prevalence was higher in females (n = 11, 4.6%) compared to males (n = 5, 3.1%), with a female:male ratio of 1.5:1. The most common triggers associated with migraine were study-related stress (88%) and emotional-related stress (81%).Conclusions: This project was undertaken to evaluate prevalence, triggers, and coping strategies of migraine among medical students. The prevalence of migraine headache in this study was lower compared to other national and international universities, with a higher female to male ratio. Stress was a major trigger among our study population. The findings of this study will add to the growing body of literature on migraine.

Coping strategies, optimism, and resilience factors associated with mental health outcomes among medical residents exposed to coronavirus disease 2019 in Qatar.

OBJECTIVE: The aim of this study is to examine the association between coping strategies, resilience, optimism and different mental health outcomes like stress, anxiety, and depression among the medical residents' during the COVID-19 pandemic, with consideration of different factors like seniority, frontliner, gender, and coping style. METHODS: An electronic survey was sent to all medical residents in Qatar. Depression, anxiety, and stress were assessed by the DASS-21. Professional quality of life was measured by the ProQOL scale. The coping mechanisms were assessed with the Brief-COPE, and resilience was measured by the Brief Resilience Scale. RESULTS: The most commonly used coping strategies were acceptance, religion, and active coping. The avoidant coping style scores were higher among junior residents (p = .032) and non-COVID-19 frontliners (p = .039). Optimism LOT-R score was higher in senior than in junior residents (p < .001). Lower avoidant coping scores, higher optimism, and higher resilience were associated with lower stress, anxiety, and depressive symptoms. CONCLUSION: It seems that avoidant coping styles can exacerbate depressive, anxiety, and stress symptoms in medical residents amidst the COVID-19 pandemic. Strategies promoting optimism, resilience, and approach coping styles can decrease the mental health burden of the pandemic on medical residents.

Burnout and Associated Risk Factors in Pediatric Residents.

Background: Burnout is a syndrome characterized by emotional exhaustion, depersonalization, and a low sense of personal accomplishment. The aim of this study was to identify burnout incidence in pediatric residents and evaluate possible risk factors for burnout. Methods: Using a cross-sectional study design, we approached all pediatric residents in the Saudi Pediatrics Residency Program in Riyadh, Saudi Arabia (n=457) between January and March 2019. The Maslach Burnout Inventory-Human Services Survey was used to assess burnout incidence. In addition, demographic factors, schedule burden, career choice satisfaction, and work-life balance were assessed. Results: The response rate was 57.8% (264/457). Males represented 46.6%. Only 14% of the residents in the study were satisfied with their work-life balance, and 62% were satisfied with their career choice of pediatrics. The overall high burnout incidence was 15.9%, the high emotional exhaustion incidence was 63.6%, the high depersonalization incidence was 27.7%, and the low sense of personal accomplishment incidence was 48.5%. In the multivariate analysis, an increase in the average number of on-calls per month (odds ratio [OR]=1.66, 95% CI 1.12-2.46; P=0.012) and satisfaction with salary (OR=0.47, 95% CI 0.33-0.66; P<0.001) showed significant associations with high overall burnout. Conclusion: We found a high level of emotional exhaustion and a low sense of personal accomplishment among respondents. However, less than one-third of residents had feelings of depersonalization or overall high burnout. Residency program directors may need to make modifications in their programs to ensure a good work-life balance for residents that will help ensure that these physicians provide safe and sustained patient care.

Al Wakra type II myocardial infarction-a case report in our emergency department.

In our emergency department (ED), we found one interesting case that had dramatic deterioration. The patient initially presented with a fever that deteriorated to sepsis, then a septic shock and chest discomfort and finally resulting in an intensive care unit (ICU) admission. He waited more than 6 hours in the waiting area, for a bed in an observation room. Phlebotomy and supportive treatment were provided in the waiting area but maybe it needed more rapid treatment to avoid the serious complications. The case rapidly deteriorated as type II myocardial infarction (MI). Al WAKRA TYPE II MI, is a case report for type II MI developed in ED as complication of prolonged waiting time in overcrowded ED, its simple fever case getting deterioration to sepsis then type II MI after prolonged waiting time in the waiting area of ED to get a bed in the observation room. We aim to report a case of type II MI in ED as rare case developed in overcrowded ED, to put highlight about overcrowded ED and how to manage it to avoid this complication again, also to be aware about pre sepsis presentation in ED with full consideration about sepsis complication and management. It could be considered as a case study for the Quality in overcrowded ED.

Cyclooxygenase-2 Gene Polymorphisms -765G>C and -1195A>G and Mycosis Fungoides Risk.

BACKGROUND: Cyclooxygenase-2 (COX-2) is an inducible modulator of inflammation that acts through increasing prostaglandin levels and has been described as a major mediator linking inflammation to cancer. Previous studies supported that COX-2-765G>C and -1195A>G polymorphisms were associated with increased risk of several solid tissue cancers as well as some hematological malignancies. OBJECTIVE: The aim of the study was to elucidate the association between functional COX-2 genotypes (-765G>C and -1195A>G) polymorphisms and the risk of developing mycosis fungoides (MF). METHODS: This was a hospital-based, case-control study of 70 MF patients and 100 MF-free controls. We genotyped COX-2 -1195A>G, -765G>C, and -8473T>C polymorphisms by using the PCR-restriction fragment length polymorphism method. RESULTS: The AA genotype in the COX-2 -1195A>G gene polymorphism and the GC genotype in the COX-2 -765G>C gene were significantly more frequent among MF patients compared to controls (p< 0.001 and p = 0.002, respectively). CONCLUSION: The -results indicate a possible role of COX-2 genes in the pathogenesis of MF. These novel findings may allow for notable future advances, as it will enable the identification of the -individuals most susceptible to MF.

The efficacy of intradermal injections of botulinum toxin in the management of enlarged facial pores and seborrhea: a split face-controlled study.

BACKGROUND: Enlarged facial pores are becoming a matter of cosmetic concern. Injections of (botulinum toxin type A) have an increasing popularity among cosmetic procedures. OBJECTIVE: To determine the efficacy and safety of intradermal injection of botulinum toxin in treatment of excess sebum secretion and enlarged facial pores. MATERIALS AND METHODS: This split face-controlled pilot study was conducted on 20 patients with enlarged facial pores and seborrhea. One cheek was treated by intradermal injection of botulinum toxin, and the other was injected by saline. Patient assessment was performed after 1 and then after 4 months. RESULTS: At 1-month assessment, both sides showed significant reduction in their sebum and pore scores (p = .001), with significantly more improvement on the botulinum toxin-treated side. Dermoscopy documented a significant decrease in the average size of facial pores (p < .001), and the OCT demonstrated a significant increase in the dermal thickness (p < .001) with non-significant deference between both sides. Four months after treatment, the botulinum toxin-treated side maintained its improvement in both scores. CONCLUSION: Intradermal injection of botulinum toxin is an effective and safe procedure for the management of excess sebum and facial pores with acceptable results lasting for an average of 4 months.

Trichoscopy as an evaluation method for alopecia areata treatment: A comparative study.

BACKGROUND: Trichoscopy is a useful tool for diagnosis and follow-up of alopecia areata (AA) patients. Both platelet-rich plasma (PRP) and intralesional corticosteroids (ILCs) are important treatment modalities of patchy AA. AIM: Trichoscopic diagnosis of AA and monitoring the treatment response to PRP versus ILCs in patchy AA treatment. PATIENTS/METHODS: This comparative study included 31 patients with patchy AA, divided into two groups: (group A) received ILCs while (group B) received PRP once monthly for 3 months. Evaluation was done by Severity of Alopecia Tool (SALT) score, Alopecia Areata Symptom Impact Scale (AASIS), photography, and dermoscopy. RESULTS: There was a significant improvement in trichoscopic findings in both groups with regard to the number of follicular units per opening, black dots, broken hairs, and dystrophic changes. Final SALT score showed significant lower levels in both groups compared to baseline levels (P = .025 & P = .008). Final AASIS showed significant decrease in group B (P = .006) not in group A (P = .062). CONCLUSION: Trichoscopy can help in the diagnosis, evaluation of the efficacy and safety of both modalities and might give a clue for treatment response. Both ILCs and PRP were effective in patchy AA treatment.

Heavy metal intake and health risk implications from consumption of dried pulses in Trinidad and Tobago, W.I.

The increase in urbanisation and industrialisation have contributed significantly to elevated concentrations of heavy metals in soils. The eventual uptake of heavy metals by agronomic crops could potentially affect human health based on consumption patterns in various regions of the globe. This study investigated the potential health risks to consumers of dried legumes in a small island developing state that rely primarily on the importation of those crops from major producers. Several varieties were analysed for selected heavy metals in which Cd and Pb were not detected and Cr was only present in certain legumes. The concentrations of Cu, Mn, Ni, and Zn were all below the established World Health Organisation (WHO) maximum permissible limit (MPL) and the target hazard quotient (THQ) and hazard index (HI) values were below one for all samples, suggesting no non-carcinogenic risk to consumers.

Dermoscopy as a useful tool for evaluating melasma and assessing the response to 1064-nm Q-switched Nd:YAG laser.

Melasma is a hard-to-manage disorder with considerable relapsing behavior. Dermoscopy emerged to help in comprehensive evaluation of pigmentary disorders and melasma. The aim of the study was to evaluate the potential role of dermoscopy in assessing melasma and monitoring the efficacy of 1064-nm low-fluence Q-switched neodymium:yttrium-aluminum-garnet (QS Nd:YAG) laser. A total of 31 patients with facial melasma were included. A total of five laser sessions were performed with 2-week intervals. Patients were evaluated at baseline and 2 weeks after the last session (at the 10th week) by using digital photography, modified melasma area and severity index (mMASI), and colorimetry, as well as dermoscopic score for pigment and vascular elements. Adverse effects were reported. Postlaser sessions, mMASI scores as well as the colorimetric melanin and erythema indices had showed significant improvement. The "dermoscopic score of pigmentary and vascular elements" displayed significant change and confirmed the improvement. Side effects were tolerable. mMASI, colorimetry, and dermoscopy had ascertained the efficacy of low-fluence 1064-nm QS Nd:YAG laser in melasma; however, dermoscopy is superior to other assessments as it can help in the diagnosis of melasma besides the follow-up assessment and can precisely detect the detailed changes in response to treatment.

Clinical and Histological Assessment of Combined Fractional CO2 Laser and Growth Factors Versus Fractional CO2 Laser Alone in the Treatment of Facial Mature Burn Scars: A Pilot Split-Face Study.

BACKGROUND AND OBJECTIVES: To investigate the therapeutic efficacy and safety of growth factors combined with fractional carbon dioxide (CO2 ) laser in comparison with fractional CO2 alone in a sample of patients with facial mature burn scars. STUDY DESIGN/MATERIALS AND METHODS: Fifteen Egyptian patients with bilateral facial burn scars were treated with six sessions of fractional CO2 laser at 6-week intervals. Following each laser session, a topical growth factors cocktail was applied to one side of the face in a split-face manner. Clinical evaluation by Vancouver Scar Scale (VSS), Patient and Observer Scar Assessment Scale (PSOS), and photography before and 2 months after the last laser session was done. Three millimeter punch biopsies were obtained from each side of the face pre- and 1-month posttreatment to measure the mean area percent of collagen. RESULTS: Posttreatment, both VSS and PSOS scores decreased on both sides of the face being more significant on the growth factors treated side, showing more scar pliability and shorter downtime (P = 0.001). A significant difference in the mean area percent of collagen was also noted on both sides. CONCLUSION: Adding topical growth factors to fractional CO2 laser treatments is effective and safe with better results as regards scar pliability and shorter downtime than fractional CO2 laser alone. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.