Background: After the outbreak of the corona virus disease-19 (COVID-19) pandemic, teledermatology was implemented in the Hungarian public healthcare system for the first time. Our objective was to assess aggregated diagnostic agreements and to determine the effectiveness of an asynchronous teledermatology system for skin cancer screening. Methods: This retrospective single-center study included cases submitted for teledermatology consultation during the first wave of the COVID-19 pandemic. Follow-up of the patients was performed to collect the results of any subsequent personal examination. Results: 749 patients with 779 lesions were involved. 15 malignant melanomas (9.9%), 78 basal cell carcinomas (51.3%), 21 squamous cell carcinomas (13.8%), 7 other malignancies (4.6%) and 31 actinic keratoses (20.4%) were confirmed. 87 malignancies were diagnosed in the high-urgency group (42.2%), 49 malignancies in the moderate-urgency group (21.6%) and 16 malignancies in the low-urgency group (4.6%) (p < 0.0001). Agreement of malignancies was substantial for primary (86.3%; κ = 0.647) and aggregated diagnoses (85.3%; κ = 0.644). Agreement of total lesions was also substantial for primary (81.2%; κ = 0.769) and aggregated diagnoses (87.9%; κ = 0.754). Conclusions: Our findings showed that asynchronous teledermatology using a mobile phone application served as an accurate skin cancer screening system during the first wave of the COVID-19 pandemic.
Background: Chronic wounds place a heavy burden on the healthcare system due to the prolonged, continuous need for human resources for wound management. Our aim was to investigate the therapeutic effects of platelet-rich plasma on the treatment of chronic wounds. Methods: The systematic literature search was performed in four databases. Randomized clinical trials reporting on patients with chronic wounds treated with platelet-rich plasma (PRP) were included, comparing PRP with conventional ulcer therapy. We pooled the data using the random effects model. Our primary outcome was the change in wound size. Results: Our systematic search provided 2688 articles, and we identified 48 eligible studies after the selection and citation search. Thirty-three study groups of 29 RCTs with a total of 2198 wounds showed that the odds for complete closure were significantly higher in the PRP group than in the control group (OR = 5.32; CI: 3.37; 8.40; I2 = 58%). Conclusion: PRP is a safe and effective modality to enhance wound healing. By implementing it in clinical practice, platelet-rich plasma could become a widely used, valuable tool as it could not only improve patients’ quality of life but also decrease the healthcare burden of wound management.
Objective: Our study aims to evaluate the effectiveness of mastoid obliteration compared to the canal wall up (CWU) technique in cholesteatoma surgery based on the systematic review of the literature and the meta-analysis of the data.Methods: The systematic search was performed in four major databases (MEDLINE, Web of Science, Embase, and CENTRAL) on October 14, 2021. Studies comparing the CWU technique and mastoid obliteration were included. The exclusion criteria were less than 12 months follow-up, congenital cholesteatoma, indefinite description of the surgical method, and animal studies. The protocol was registered on Prospero (registration number: CRD42021282485). The risk of bias was evaluated with the ROBINS-I tool. Residual and recurrent disease proportions as primary outcomes, quality of life, ear discharge, infection rates, hearing results, and operation time as secondary outcomes were analyzed. In the quantitative synthesis, the random effect model was used, and heterogeneity was identified.Results: A total of 11 articles with 2077 operations' data were found eligible. All the identified studies were retrospective cohorts. The odds of pooled residual and recurrent disease proportion were significantly lower in the obliteration group compared to CWU (OR = 0.45, CI:0.28;0.80, p = 0.014). However, when separated, the proportion of ears with recurrent (OR = 0.41, CI:0.11;1.57, p = 0.140) or residual (OR = 0.59, CI:0.23, 1.50, p = 0.207) disease did not show a significant difference, even though the odds were quite similar. The qualitative synthesis identified no significant difference in the secondary outcomes, but obliteration elongated the operation time.Conclusion: Mastoid obliteration significantly decreased the proportion of residual and recurrent cholesteatoma in pooled analyses compared to the CWU technique with low-quality of data.
Introduction: The incidence of melanoma increased considerably in recent decades, representing a significant public health problem. We aimed to evaluate the ability of non-specialists for the preliminary screening of skin lesions to identify melanoma-suspect lesions. Materials and Methods: A medical student and a dermatologist specialist examined the total body scans of 50 patients. Results: The agreement between the expert and the non-specialist was 87.75% (κ = 0.65) regarding the assessment of clinical significance. The four parameters of the ABCD rule were evaluated on the 129 lesions rated as clinically significant by both observers. Asymmetry was evaluated similarly in 79.9% (κ = 0.59), irregular borders in 74.4% (κ = 0.50), color in 81.4% (κ = 0.57), and diameter in 89.9% (κ = 0.77) of the cases. The concordance of the two groups was 96.9% (κ = 0.83) in the case of the detection of the Ugly Duckling Sign. Conclusions: Although the involvement of GPs is part of routine care worldwide, emphasizing the importance of educating medical students and general practitioners is crucial, as many European countries lack structured melanoma screening training programs targeting non-dermatologists.
The social distancing measures introduced due to the COVID-19 pandemic may have affected the sexual behavior of the population. We collected data retrospectively from the National STD Center of Hungary. The overall patient influx data of the STD Center and the number of patients diagnosed with syphilis, chlamydia, and gonorrhea infections were assessed in the three-month period of 2020 when the strict governmental lockdown was introduced in Hungary. Data were compared to the pre- and post-lockdown quarters of 2020 and matched to the respective quarters of 2018 and 2019. The number of patients diagnosed with syphilis and chlamydia infections in 2020 during the lockdown decreased compared to 2018 and 2019, while the number of gonorrhea cases increased. The lower number of STI screenings resulted in a significant decrease in asymptomatic syphilis and chlamydia case numbers. However, the growing number of gonorrhea cases in 2020 during lockdown highlights that sexual behavior remained unchanged regardless of restrictions. Therefore, gonorrhea may be considered as an indicator of STI incidences during the pandemic.
Objectives The multi-biomarker disease activity (MBDA) score is an objective tool for monitoring disease activity in rheumatoid arthritis (RA). Here we report a systematic review and meta-analysis of the clinical value of the MBDA score in RA. Methods We performed a systematic literature search in five medical databases: MEDLINE (via PubMed), Cochrane Library (CENTRAL), Embase, Scopus, and Web of Science, from inception to 13 October 2021. Original articles reporting on the performance of the MBDA score’s correlation with conventional disease activity measures, or the predictive and the discriminative value of the MBDA score for radiographic progression, therapy response, remission, and relapse were included. Results Our systematic search provided a total of 1190 records. After selection and citation searches, we identified 32 eligible studies. We recorded moderate correlations between MBDA score and conventional DAMs at baseline (COR = 0.45, CI: 0.28–0.59; I2 = 71.0% for DAS28 CRP and COR = 0.55, CI: 0.19–0.78; I2 = 0.0% for DAS28-ESR) and at follow-up (COR = 0.44, CI: 0.28–0.57; I2 = 70.0% for DAS28 CRP), and found that the odds of radiographic progression were significantly higher for patients with a high baseline MBDA score (>44) than for patients with a low baseline MBDA score (<30) (OR = 1.03, CI: 1.02–1.05; I2 = 10.0%). Conclusion MBDA score might be used as an objective disease activity marker. In addition, it is also a reliable prognostic marker of radiographic progression.
Background: Alopecia areata (AA) is a chronic autoimmune condition that can lead to a serious deterioration in patients’ quality of life. The first line of treatment in patchy AA is triamcinolone acetonide (TrA); however, the efficacy of the treatment varies greatly. Our aim was to investigate the therapeutic effects of platelet-rich plasma (PRP) in the treatment of AA. Method: We performed a systematic literature search in four databases. Randomized clinical trials (RCT) reporting on patients with AA treated with PRP were included, comparing PRP with TrA or a placebo. The primary outcome was the Severity of Alopecia Tool (SALT) score. Results: Our systematic search provided a total of 2747 articles. We identified four studies eligible for quantitative analysis. The pooled mean differences from the four studies did not exhibit a significant difference in the mean change in the SALT score when PRP and TrA groups were compared (MD =−2.04, CI: −4.72–0.65; I2 = 80.4%, p = 0.14). Conclusions: PRP is a promising topical, steroid-free treatment modality in the therapy of AA. No significant difference was found between PRP and TrA treatment; however, further high-quality RCTs are needed to further assess the efficacy of PRP treatment and strengthen the quality of evidence.
Alopecia areata (AA) is an immune-mediated hair loss disorder characterized by elevated levels of IFNg and Th1-driven inflammatory responses toward the hair follicle (HF) bulb. This results in immune privilege (IP) collapse, premature catagen development, and HF dystrophy. Given the critical role of interleukin (IL)-12 in priming Th1 responses, we investigated whether IL-12 could be directly involved in inducing HF-IP collapse and whether the selective tyrosine kinase 2 (TYK2) inhibitor, BMS-986202, could prevent or reverse the process. By quantitative immunohistomorphometry, we showed that ex vivo treatment of microdissected HFs with IL-12 (3 ng/mL) + IL-18 (20 ng/mL) upregulated MHC-I and II as well as MICA/B expression in the hair bulb (cardinal features of IP collapse), increased the numbers of CD3 + or CD56 + cells in HF epithelium and mesenchyme, and selectively enriched IFNginducible genes. In addition, more peribulbar IL-12RB2+ cells were found in acute lesional scalp skin samples of AA patients than healthy controls. We further confirmed the role of IL-12 in the HF-IP collapse by selectively blocking IL-12 receptor signaling. BMS-986202 (300 nM), when administered to microdissected HFs before or after IL-12 + IL-18 stimulation, prevented or attenuated the expression of MHC-I and II as well as secretion of IFNg. Therefore, our data demonstrate that local IL-12 directly promotes perifollicular immune cell expansion, IFNg secretion, and HF-IP collapse. These findings support a potential role of IL-12 signaling in AA pathogenesis and highlight IL-12 as a potential new target for pharmacologic AA therapy.
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