5-Fluorouracil in the Treatment of Keloids and Hypertrophic Scars: A Comprehensive Review of the Literature

Hypertrophic (HTSs) and keloid scars are common dermatological complaints produced by disruption of the normal wound-healing process. Despite a wide array of therapeutic options available to treat these lesions, HTSs and keloids continue to pose a significant challenge to clinicians in everyday practice. The chemotherapeutic drug 5-fluorouracil (5-FU) is a well-known treatment option reserved for recalcitrant HTSs and keloid lesions. We present clinicians with a comprehensive review of the published data concerning the use of 5-FU in the treatment of HTSs and keloids. The current evidence suggests that 5-FU is a safe and practical alternative for the treatment of HTSs and keloids as it may substantially improve the appearance of proliferative scars and reduce the chance of recurrence. This therapeutic option is most effective in conjunction with adjuvant therapy such as corticosteroids. Additional randomized controlled clinical trials with large sample sizes should be conducted to corroborate the existing efficacy and safety data in patients with HTSs and keloids. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s13555-016-0118-5) contains supplementary material, which is available to authorized users

A Qualitative Survey Study in Managing Patient Obesity for Exploring Self Efficacy among Saudi General Practitioners

This study aimed at investigate the management of obesity patients for exploring the self-efficacy among Saudi general practitioners in a qualitative survey methodology, by conducting interviews that were recorded digitally and transcribed verbatim by a professional transcription service. DE identified data were transferred into NVivo 10 for data organisation and coding. Data were analysed independently by the researchers and coded using social cognitive theory as a guiding framework. Twenty GPs recruited via a snowball sampling strategy to deliver a pilot of an obesity management program (“The Change Program”) participated in semi structured interviews before commencing the pilot. Of the 20 participating GPs (twelve  males and eight female), ages ranged between 33 and 55, and years working in general practice ranged between 5 and 25. The Interviews were face-to-face and were conducted in June and July of 2017. The study concluded that shifting the frame away from weight loss per se and towards these other goals might therefore allow for a more authentic GP-patient interaction and increase the self-efficacy of both GP and patient for healthy lifestyle changes

Lipid nanocarriers overlaid with chitosan for brain delivery of berberine via the nasal route

This research aimed to design, optimize, and evaluate berberine-laden nanostructured lipid carriers overlaid with chitosan (BER-CTS-NLCs) for efficient brain delivery via the intranasal route. The nanostructured lipid carriers containing berberine (BER-NLCs) were formulated via hot homogenization and ultrasonication strategy and optimized for the influence of a variety of causal variables, including the amount of glycerol monostearate (solid lipid), poloxamer 407 (surfactant) concentration, and oleic acid (liquid lipid) amount, on size of the particles, entrapment, and the total drug release after 24 h. The optimal BER-NLCs formulation was then coated with chitosan. Their diameter, in vitro release, surface charge, morphology, ex vivo permeability, pH, histological, and in vivo (pharmacokinetics and brain uptake) parameters were estimated. BER-CTS-NLCs had a size of 180.9 ± 4.3 nm, sustained-release properties, positive surface charge of 36.8 mV, and augmented ex-vivo permeation via nasal mucosa. The histopathological assessment revealed that the BER-CTS-NLCs system is safe for nasal delivery. Pharmacokinetic and brain accumulation experiments showed that animals treated intranasally with BER-CTS-NLCs had substantially greater drug levels in the brain. The ratios of BER brain/blood levels at 30 min, AUCbrain/AUCblood, drug transport percentage, and drug targeting efficiency for BER-CTS-NLCs (IN) were higher compared to BER solution (IN), suggesting enhanced brain targeting. The optimized nanoparticulate system is speculated to be a successful approach for boosting the effect of BER in treating CNS diseases, such as Alzheimer’s disease, through intranasal therapy

Efficacy and safety of lasers in treating syringomas: a review of the literature

Syringomas are benign adnexal neoplasms that may induce psychological stress when they are large or disfiguring or present in delicate regions such as the periorbital area. Despite the availability of various lasers for syringomas, no consensus has been established on the optimal laser setting and side effects of these therapies. The current review aims at understanding the efficacy and safety of various laser therapies available for the treatment of syringomas. A literature search was carried out using PubMed and Ovid databases for articles published from Jan 2000 through Mar 2022. Screening the eligible articles yielded 27 studies, comprising clinical studies, case series, and case reports, which were included in this review. The CO2 laser is the most widely used ablative laser therapy but is usually associated with adverse events. Pinhole and multiple drilling methods using CO2 laser yielded excellent cosmetic results with minimal adverse effects. Fractional lasers reduced the downtime and complications compared to non-fractionated ones. Non-ablative fractional lasers could be advantageous in terms of easy operation, minimal side effects and moderate recovery period compared with ablative lasers. Large clinical trials are needed to generate strong evidence to guide clinicians in choosing the most appropriate laser therapy for syringoma treatment

Kaposi Sarcoma in a Child after Fanconi Anemia-Induced Haploidentical Hematopoietic Stem Cell Transplant: A Case Report

Kaposi sarcoma is relatively common after solid organ transplantation, but very rare after hematopoietic stem cell transplant (HSCT). Here we are reporting a rare case of Kaposi sarcoma in a child after HSCT. An 11-year-old boy with Fanconi anemia was treated by haploidentical HSCT from his father. Three weeks after transplantation, the patient developed severe graft-versus-host disease (GVHD) which was treated by immunosuppressive therapy and extracorporeal photopheresis. Approximately 6.5 months after HSCT, the patient had asymptomatic nodular skin lesions over the scalp, chest, and face. Histopathological examination showed typical findings of Kaposi sarcoma. Later, additional lesions in the liver and oral cavity were confirmed. Liver biopsy was positive for HHV-8 antibodies. The patient was continued on Sirolimus which was already being used for the treatment of GVHD. Cutaneous lesions were also treated with topical timolol 0.5% ophthalmic solution. Within six months, cutaneous and mucous membrane lesions were completely resolved. Follow-up abdominal ultrasound and MRI showed the disappearance of the hepatic lesion

Prevalência e Qualidade de Consentimento Informado para Pacientes Submetendo-se a Procedimentos Cosméticos: Um Estudo Transversal

Background: Failure of the physician to disclose potential risks and benefits associated with cosmetic procedures is one of the main causes of legal disputes over informed consent. The objective was to assess the prevalence and quality of the informed consent given by patients who undergone cosmetic procedures and its association with post-procedure adverse events. Methods: It was a cross-sectional, online, questionnaire-based study conducted during September and October 2020. Eligible adult male and female patients who were attending a governmental dermatology clinic at Al-Kharj city (Saudi Arabia) were invited to join the study. Results: A total of 246 patients were included in the study. Out of 246, 111 (45.1%) patients performed at least one cosmetic procedure before, and 89 (80.2%) of them signed an informed consent. 62 (69.7%) of them signed a consent before the procedure, 17 (19.1%) reported post-procedure adverse events, 16 (18.0%) reported dissatisfactions, and 27 (30.3%) reported either. None of the consent characteristics were significantly associated with higher prevalence of post-procedure adverse events or non-satisfactions. Conclusions: The prevalence and the quality of informed consent before cosmetic procedures are inadequate. Urgent corrections are required to protect the patient’s rights and to legally protect the treating physician.Antecedentes: El hecho de que el médico no revele los posibles riesgos y beneficios asociados a los procedimientos estéticos es una de las principales causas de las disputas legales sobre el consentimiento informado. El objetivo fue evaluar la prevalencia y la calidad del consentimiento informado dado por los pacientes sometidos a procedimientos estéticos y su asociación con los eventos adversos posteriores al procedimiento. Métodos: Fue un estudio transversal, online, basado en un cuestionario, realizado durante septiembre y octubre de 2020. Se invitó a participar en el estudio a pacientes adultos de ambos sexos que acudían a una clínica dermatológica gubernamental en la ciudad de Al-Kharj (Arabia Saudí). Resultados: Un total de 246 pacientes fueron incluidos en el estudio. De los 246, 111 (45,1%) pacientes se habían sometido al menos a un procedimiento cosmético antes, y 89 (80,2%) de ellos firmaron un consentimiento informado. 62 (69,7%) de ellos firmaron un consentimiento antes del procedimiento, 17 (19,1%) informaron de acontecimientos adversos posteriores al procedimiento, 16 (18,0%) informaron de insatisfacciones y 27 (30,3%) informaron de cualquiera de los dos. Ninguna de las características del consentimiento se asoció significativamente con una mayor prevalencia de acontecimientos adversos posteriores al procedimiento o insatisfacciones. Conclusiones: La prevalencia y la calidad del consentimiento informado antes de los procedimientos cosméticos son inadecuadas. Se requieren correcciones urgentes para proteger los derechos del paciente y proteger legalmente al médico tratante.Contexto: A falha do médico em comunicar os potenciais riscos e benefícios associados a procedimentos cosméticos é uma das principais causas de disputas legais sobre consentimento informado. O objetivo foi avaliar a prevalência e qualidade do consentimento informado dado a pacientes que sofreram procedimentos cosméticos e sua associação com eventos adversos pós-procedimento. Métodos: Estudo transversal, online, baseado em questionário, realizado durante setembro e outubro de 2020. Pacientes homens e mulheres, adultos elegíveis, de uma clínica dermatológica governamental da cidade de Al-Kharj (Arábia Saudita) foram convidados a participar do estudo. Resultados: Um total de 246 pacientes foram incluídos no estudo. Dos 246, 111 (45.1%) pacientes realizaram pelo menos um procedimento cosmético anterior e 89 (80.2%) deles assinaram um consentimento informado. 62 (69.7%) deles assinaram um consentimento antes do procedimento, 17 (19.1%) relataram eventos adversos pós-procedimento, 16 (18.0%) relataram insatisfações e 27 (30.3%) relataram ambos. Nenhuma das características do consentimento foram significativamente associadas com mais alta prevalência de eventos adversos pós-procedimento ou não satisfação. Conclusões: A prevalência e a qualidade do consentimento informado antes de procedimentos cosméticos são inadequados. Correções urgentes são requeridas para proteger os direitos dos pacientes e para legalmente proteger o médico responsável

Current practice and beliefs of parents toward sunscreen use for their children: A cross-sectional study

Parents are generally influencing the sun protection behaviors of their children, including sunscreen use. In Saudi Arabia, sunscreen use was estimated in adults but not children. The objective was to estimate the prevalence and predictors of sunscreen use among parents and their children. An observational cross-sectional study was conducted in April 2022. Parents who were visiting outpatient clinics at a university hospital in Al-Kharj city, Saudi Arabia, were invited to complete an online questionnaire. A total of 266 participants were included in the final analysis. The mean age of parents was 39.0 ± 8.9 years, and the mean age of children was 8.2 ± 3.2 years. The prevalence of sunscreen use was 38.7% in parents and 24.1% in their children. Females had higher sunscreen use than males in both parents (49.7% versus 7.2%, p < 0.001) and in children (31.9% versus 18.3%, p = 0.011). The most frequent sunburn protection measures practiced by children were wearing long-sleeved clothes (77.0%), sitting in the shade (70.6%), and wearing hats (39.2%). In multivariable analysis, predictors of sunscreen use in parents included female sex, history of sunburn, and sunscreen use by children. Independent predictors of sunscreen use in children included a history of sunburn, wearing hats, and practicing other sunburn protection measures on risky occasions, and sunscreen use in parents. Sunscreen use in parents and children in Saudi Arabia is still inadequate or limited. This calls for community/school intervention programs using educational activities and multimedia promotion. Further studies are needed