The dermoscope allows physicians to examine the macroscopic and microscopic primary morphology of skin lesions, identify subtle clinical clues, confirm naked-eye clinical diagnoses, and monitor treatment progress while posing little threat to the young patient. This review summarizes important dermoscopic structures seen in infectious and inflammatory skin conditions and hair disorders in children. Scabies, pediculosis, phthiriasis, molluscum contagiosum, tinea nigra, and verrucae are well characterized dermoscopically by delta-shaped structures, ovoid-shaped nits, the crab louse, red corona, brown strands or spicules, and multiple densely packed papilla with a central black dot surrounded by a whitish halo, respectively. These dermoscopic structures will be discussed, focusing on the dermoscopic morphologies and dermoscopic sensitivity for diagnosis and its utility in monitoring treatment progress. Dermoscopy has also been shown to significantly improve the clinician's diagnostic and monitoring accuracy of inflammatory skin lesions such as psoriasis, which is characterized dermoscopically by uniformly distributed dotted blood vessels, and lichen planus, which is characterized by whitish lines on a purple to reddish background. Dermoscopy of the hair and scalp (trichoscopy) facilitates the differential diagnosis of hair diseases in children, including alopecia areata, trichotillomania, and tinea capitis. It can also assist in the diagnosis of multiple genetic hair shaft disorders, such as monilethrix, trichorrhexis invaginata, trichorrhexis nodosa, pili torti, and pili annulati.
Genetic syndromes including basal cell nevus syndrome (BSNS), xeroderma pigmentosum (XP), and epidermodysplasia verruciformis (EV) predispose the individual to skin cancer. Basal cell carcinomas (BCCs) often develop in patients with BCNS and XP. One of the aims of surveillance examination in these patients is to detect BCC while the tumors are still small and easy to manage. Dermoscopy, by allowing the visualization of arborizing vessels, ovoid nests, nonaggregated blue-gray globules, and spoke-wheel and leaf-like structures, can facilitate in the early detection of BCC. Patients with XP are also at risk for developing squamous cell carcinoma (SCC). Dermoscopy can assist in the early detection of these cancers by allowing the observer to visualize focal glomerular vessels, which is a common feature seen in SCC. This feature can also assist in detecting SCC developing in other syndromes such as EV and epidermolysis bullosa (EB). In addition to helping in the detection of BCC and SCC, dermoscopy can also help detect melanoma in individuals with XP and evaluate nevi developing in those with EB. This review will discuss how dermoscopy can be used in the management of patients with BSNS, XP, EV, and EB and will discuss the dermoscopic findings of vascular lesions, including pyogenic granuloma, hemangioma, port-wine stain, and lymphangioma circumscriptum.
Melanocytic nevi encompass a variety of lesions, including blue, Spitz, congenital, and acquired nevi. These nevi can occasionally manifest clinical morphologies resembling melanoma, and the presence of such nevi in children can elicit anxiety in patients, parents, and clinicians. Dermoscopy has been shown to increase the diagnostic accuracy for melanoma and to help differentiate melanoma from nevi, ultimately aiding in the decision-making process as to whether to perform a biopsy. Dermoscopy is the perfect instrument to use during the evaluation of pigmented skin lesions in children because it is painless and provides important information for the clinician that can assist in formulating appropriate management decisions. This review highlights the most common benign dermoscopic patterns encountered in nevi and discuss the 10 most common dermoscopic structures seen in melanomas. Lesions manifesting a benign dermoscopic pattern and lacking any melanoma-specific structures do not need to be excised and can safely be monitored. In contrast, melanomas will invariably deviate from the benign nevus patterns and will usually manifest at least 1 of the 10 melanoma-specific structures: atypical network, negative network, streaks, crystalline structures, atypical dots and globules, irregular blotch, blue-white veil, regression structures, peripheral brown structureless areas, and atypical vessels. It is important to be cognizant of the fact that melanomas in childhood usually do not manifest the clinical ABCD features. Instead, they are often symmetric, amelanotic, nodular lesions. Although the clinical appearance may not be alarming, with dermoscopy they will invariably manifest at least one melanoma-specific structure, the most common being atypical vascular structures and crystalline structures.
Previous research demonstrates that ADHD is considered a risk factor for COVID-19. The current study attempts to investigate the relationships between infection, mortality and recovery rates from coronavirus and the prevalence of ADHD at the US statewide level. Based on information from 2011 regarding the prevalence of ADHD across the US by state, findings suggest that, while there are no correlations between ADHD and population size, infection and mortality rates from coronavirus, recovery rates (recovery-population ratio) rise with the prevalence of ADHD. Consequently, a possible explanation is that in coping with the disease, ADHD might provide an evolutionary advantage. An example of this phenomenon can be found in the gene that causes sickle-cell disease, which, as a non-dominant gene, helps cope with infection from malaria. If corroborated, research findings may support the conclusion that coronavirus limitations in special educational frameworks for ADHD would not be required or could be relaxed. JEL Codes: H75, I12
Coronavirus disease 2019 (COVID-19) is a declared global pandemic with multiple risk factors. Based on recent empirical studies, obesity is considered by several researchers as one of the serious risk factors for coronavirus-related complications. Yet, other scholars argue in favor of the existence of an obesity survival paradox. The objective of the current study is to analyze the potential relationships between different corona indicators and obesity on a statewide level. Since the United States is ranked as one of the OECD countries with a high level of overweight and obesity among its citizens-the majority of US states exceed the 30% benchmark of obese population-it is an especially interesting case study to explore this issue. In an attempt to estimate projected probabilities for infection by coronavirus and mortality rates as a function of obesity prevalence, the fractional logit regression is employed. Findings may support the counter-intuitive possibility of an obesity survival paradox. Consequently, ethical guidelines referring to priority in intubation and intensive care treatments should account for these complex relationships between obesity and corona. Both projected rates of infection and mortality drop with elevated prevalence of obesity. The reasons for these findings might be explained by several conditions such as elevated social distancing from more obese persons, increased metabolic reserves, more aggressive treatment, and unidentified factors that should be examined in future research.
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