A review of photodiagnostic investigations over 26 years:experience of the National Scottish Photobiology Service (1989-2015)

Background The Scottish Photobiology Service is the national referral pathway for patients with cutaneous photosensitivity diseases in Scotland. We reviewed the pattern of diagnosis of photosensitivity diseases and investigations performed between 1989 and 2015. Methods and Results Data were collected from the Photodiagnostic Database, annual reports and paper records. The total number of patients assessed each year was stable over the period studied (median 242 [range 231–266]), with most being new patients (median 69 [range 62–73]%). Monochromator phototesting was the most utilised investigation, although the use of provocation testing and photopatch testing has increased. The most common diagnosis was polymorphic light eruption, and there was a trend to increasing diagnosis of photoaggravated atopic eczema. Conclusions The pattern of diagnosis of photosensitivity diseases remains fairly stable in Scotland and we wish to emphasise the importance of this Scottish specialist service for patients with photosensitivity diseases and referrers

Filling the Gap of DataLimited Fish Species in the Eastern Mediterranean Sea: A Contribution by Citizen Science

: The biodiversity of the Mediterranean Sea is rapidly changing due to anthropogenic activity and the recent increase of seawater temperature. Citizen science is escalating as an important contributor in the inventory of rare and datalimited species. In this study, we present several records of five datalimited native fish species from the eastern Mediterranean Sea: Alectis alexandrina (Geoffroy SaintHilaire, 1817), Ranzania laevis (Pennant, 1776), Dalatias licha (Bonnaterre, 1788), Lophotus lacepede (Giorna, 1809), and Sudis hyalina (Rafinesque, 1810). All of the records were collected by a participatory process involving fishers and validated by associated taxonomic experts of the citizen science programme “Is it Alien to you? Share it!!!”. This study fills an important gap for the distribution of the reported species and signifies the important role of citizen participation as a tool for extending marine biodiversity knowledge and fisheries management in an area with several gaps of knowledge on targeted and nontargeted species.</jats:p

Improving the early identification of COVID-19 pneumonia:a narrative review

Delayed presentation of COVID-19 pneumonia increases the risk of mortality and need for high-intensity healthcare. Conversely, early identification of COVID-19 pneumonia grants an opportunity to intervene early and thus prevent more complicated, protracted and less successful hospital admissions. To improve the earlier detection of COVID-19 pneumonia in the community we provide a narrative review of current evidence examining the clinical parameters associated with early disease progression. Through an evolving literature review, we examined: the symptoms that may suggest COVID-19 progression; the timing of deterioration; the utility of basic observations, clinical examination and chest X-ray; the value of postexertion oxygen saturations; and the use of CRP to monitor disease progression. We go on to discuss the challenges in monitoring the COVID-19 patient in the community and discuss thresholds for further assessment. Confusion, persistent fever and shortness of breath were identified as worrying symptoms suggestive of COVID-19 disease progression necessitating urgent clinical contact. Importantly, a significant proportion of COVID-19 pneumonia patients appear not to suffer dyspnoea despite severe disease. Patients with this asymptomatic hypoxia seem to have a poorer prognosis. Such patients may present with other signs of hypoxia: severe fatigue, exertional fatigue and/or altered mental status. We found duration of symptoms to be largely unhelpful in determining risk, with evidence of deterioration at any point in the disease. Basic clinical parameters (pulse, respiratory rate, blood pressure, temperature and oxygen saturations (SpO(2))) are likely of high value in detecting the deteriorating community COVID-19 patient and/or COVID-19 mimickers/complications (eg, sepsis, bacterial pneumonia and pulmonary embolism). Of these, SpO(2) carried the greatest utility in detecting COVID-19 progression. CRP is an early biochemical parameter predictive of disease progression and used appropriately is likely to contribute to the early identification of COVID-19 pneumonia. Identifying progressive COVID-19 in the community is feasible using basic clinical questions and measurements. As such, if we are to limit the mortality, morbidity and the need for complicated, protracted admissions, monitoring community COVID-19 cases for signs of deterioration to facilitate early intervention is a viable strategy

Assessing the current status of Hexanchus griseus in the Mediterranean Sea using local ecological knowledge

Fishermen from 9 countries distributed throughout the Mediterranean Sea were interviewed between May and December 2019 with the aim of compiling information about the current impact of fisheries on a large deepwatershark species, the bluntnose sixgill shark (Hexanchus griseus). A total of 382 professional fishermenbelonging to 6 different gears (bottom trawling, bottom longline, drifting longline, trammel nets, gillnets andpolyvalent) took part in the study. Bottom trawlers were the most interviewed fishermen (n = 148) and the bestfleet coverage was obtained for bottom longline (38.89%). Results showed most captures of H. griseus occur in theWestern and Central Mediterranean Sea, particularly during the warm months of the year and most commonly bybottom trawlers and bottom longliners. At-vessel mortality (AVM) was rather low in all gears but a slightlyhigher degree of individual mortality is suggested in trammel and gillnets. The population trend of H. griseus inthe Mediterranean Sea could not be inferred from the interviews as answers were highly variable, but the overalltrend in some countries may suggest this species is showing signs of population decrease. The results of this studyare mostly aligned with the latest IUCN assessment but also recommend reviewing the current status of H. griseusin the Mediterranean basin. Further empirical research on post-release mortality would also be advisable toimplement measures that help reduce this source of mortality

Restricted access to the NHS during the COVID-19 pandemic : is it time to move away from the rationed clinical response?

Recently a Lancet Commission examined the future prospects of the NHS in the wake of COVID-19. The report cites poor healthcare capacity and chronic staff shortages as key contributing factors to the UK’s inadequate pandemic response. Notable strengths included universal access, the goodwill of staff, and the ability to generate innovative solutions - qualities that are likely to have averted an even deeper national crisis [1]. The prosperity of the NHS is intrinsically connected to the prosperity of the nation. Access to healthcare influences morbidity, mortality, economic activity, and whether or not social restrictions are necessary [2,3]. Public health measures such as timely implementation of social distancing are also important to limit mortality, but going forward it is the capacity to respond in a clinically effective and decisive manner that is vital to diminish the threat associated with the virus [4]. The importance of examining the national clinical response to SARS-CoV-2 cannot be overstated. Arguably the greatest mistake of this pandemic would be failing to prepare for the next. There are also the looming unknowns of SARS-CoV-2 variants [5], the higher rates of Long COVID following more severe disease [6], and the increased healthcare demands associated with delayed presentation of COVID-19 pneumonia [7-11]. Improving the tolerance of society to background levels of SARS-CoV-2 will require an improved clinical response. With this in mind, we examine one aspect of the UK’s clinical response that remains in place today: restricted access to healthcare

Antibody-associated epilepsies: Clinical features, evidence for immunotherapies and future research questions.

PURPOSE: The growing recognition of epilepsies and encephalopathies associated with autoantibodies against surface neuronal proteins (LGI1, NMDAR, CASPR2, GABABR, and AMPAR) means that epileptologists are increasingly asking questions about mechanisms of antibody-mediated epileptogenesis, and about the use of immunotherapies. This review summarizes clinical and paraclinical observations related to autoimmune epilepsies, examines the current evidence for the effectiveness of immunotherapy, and makes epilepsy-specific recommendations for future research. METHOD: Systematic literature search with summary and review of the identified publications. Studies describing the clinical characteristics of autoantibody-associated epilepsies and treatments are detailed in tables. RESULTS: Literature describing the clinical manifestations and treatment of autoimmune epilepsies associated with neuronal cell-surface autoantibodies (NSAbs) is largely limited to retrospective case series. We systematically summarize the features of particular interest to epileptologists dividing patients into those with acute or subacute encephalopathies associated with epilepsy, and those with chronic epilepsy without encephalopathy. Available observational studies suggest that immunotherapies are effective in some clinical circumstances but outcome data collection methods require greater standardization. CONCLUSIONS: The clinical experience captured suggests that clusters of clinical features associate well with specific NSAbs. Intensive and early immunotherapy is indicated when patients present with autoantibody-associated encephalopathies. It remains unclear how patients with chronic epilepsy and the same autoantibodies should be assessed and treated. Tables in this paper provide a comprehensive resource for systematic descriptions of both clinical features and treatments, and highlight limitations of current studies

Integrating Literature, Biodiversity Databases, and Citizen-Science to Reconstruct the Checklist of Chondrichthyans in Cyprus (Eastern Mediterranean Sea)

Chondrichthyans are apex predators influencing the trophic web through a top-down process thus their depletion will affect the remaining biota. Notwithstanding that, research on chondrichthyans is sparse or data-limited in several biogeographic areas worldwide, including the Levantine Sea. We revise and update the knowledge of chondrichthyans in Cyprus based on a bibliographic review that gains information retrieved from peer-reviewed and grey literature, Global Biodiversity Information Facility (135 records of at least 18 species) and the Ocean Biodiversity Information System (65 records of at least14 species), and the citizen science project Mediterranean Elasmobranchs Citizen Observations (117 records per 23 species). Our updated checklist reports 60 species that account for about 70% of the Mediterranean chondrichthyan biota. The list includes 15 more species than the previous checklist and our study reports three new species for Cyprus waters, namely the blackmouth catshark Dalatias licha, the round fantail stingray Taeniurops grabatus, and the sawback angelshark Squatina aculeata. Our research highlights the need for conservation measures and more studies regarding the highly threatened blackchin guitarfish Glaucostegus cemiculus and the devil ray Mobula mobular, and stresses the importance for training a new generation of observers to strengthen the knowledge and conservation of elasmobranchs in the region.</jats:p

Examining Associations Between Smartphone Use and Clinical Severity in Frontotemporal Dementia: Proof-of-Concept Study

BackgroundFrontotemporal lobar degeneration (FTLD) is a leading cause of dementia in individuals aged &lt;65 years. Several challenges to conducting in-person evaluations in FTLD illustrate an urgent need to develop remote, accessible, and low-burden assessment techniques. Studies of unobtrusive monitoring of at-home computer use in older adults with mild cognitive impairment show that declining function is reflected in reduced computer use; however, associations with smartphone use are unknown.ObjectiveThis study aims to characterize daily trajectories in smartphone battery use, a proxy for smartphone use, and examine relationships with clinical indicators of severity in FTLD.MethodsParticipants were 231 adults (mean age 52.5, SD 14.9 years; n=94, 40.7% men; n=223, 96.5% non-Hispanic White) enrolled in the Advancing Research and Treatment of Frontotemporal Lobar Degeneration (ARTFL study) and Longitudinal Evaluation of Familial Frontotemporal Dementia Subjects (LEFFTDS study) Longitudinal Frontotemporal Lobar Degeneration (ALLFTD) Mobile App study, including 49 (21.2%) with mild neurobehavioral changes and no functional impairment (ie, prodromal FTLD), 43 (18.6%) with neurobehavioral changes and functional impairment (ie, symptomatic FTLD), and 139 (60.2%) clinically normal adults, of whom 55 (39.6%) harbored heterozygous pathogenic or likely pathogenic variants in an autosomal dominant FTLD gene. Participants completed the Clinical Dementia Rating plus National Alzheimer's Coordinating Center Frontotemporal Lobar Degeneration Behavior and Language Domains (CDR+NACC FTLD) scale, a neuropsychological battery; the Neuropsychiatric Inventory; and brain magnetic resonance imaging. The ALLFTD Mobile App was installed on participants' smartphones for remote, passive, and continuous monitoring of smartphone use. Battery percentage was collected every 15 minutes over an average of 28 (SD 4.2; range 14-30) days. To determine whether temporal patterns of battery percentage varied as a function of disease severity, linear mixed effects models examined linear, quadratic, and cubic effects of the time of day and their interactions with each measure of disease severity on battery percentage. Models covaried for age, sex, smartphone type, and estimated smartphone age.ResultsThe CDR+NACC FTLD global score interacted with time on battery percentage such that participants with prodromal or symptomatic FTLD demonstrated less change in battery percentage throughout the day (a proxy for less smartphone use) than clinically normal participants (P&lt;.001 in both cases). Additional models showed that worse performance in all cognitive domains assessed (ie, executive functioning, memory, language, and visuospatial skills), more neuropsychiatric symptoms, and smaller brain volumes also associated with less battery use throughout the day (P&lt;.001 in all cases).ConclusionsThese findings support a proof of concept that passively collected data about smartphone use behaviors associate with clinical impairment in FTLD. This work underscores the need for future studies to develop and validate passive digital markers sensitive to longitudinal clinical decline across neurodegenerative diseases, with potential to enhance real-world monitoring of neurobehavioral change