Management of a Rare Pathology in Children it is Lipomyelomenengocele about Casis Report

The lipomyelomeningocele (LMMC) is a type of congenital occult spinal dysraphism consistent with the presence of lipomatous tissue adhering to the epinetic marrow, which falls through a defect of the vertical colon with the former meninges and the marrow under posture the skin. LMMC is the cause of the most frequent congenital attache between the cadre of the syndrome of the attached cord and causes a neurological deterioration due to the compression of the medical bone and the root system which is superadded. It is therefore about a girl from 6 years ago with a swelling located in the region of Lombardy after the birth of the size of a tangerine which has increased the size gradually with age. He presented the interrogation of the signs of urinary incontinence and the fact that he confirmed that he left us to fellow therapists who sent him to us for support. The local examination of the lumbosacral region revealed a single mass without other distinctive skin signs, spherical in shape, 12 × 10 cm, soft and fixed in consistency. A medullary MRI with effect, which reveals a mass of lipomate consistency at the level of lumbosacral associated with a bone spina extending from L5 to S2. Surgical treatment was indicated as the patient had urinary problems. There were no postoperative complications and after a few months postoperative symptoms improved.

Clinical assessment of novel plant-based moisturizer “Elovera” in management of dry skin conditions

<p class="abstract"><strong>Background: </strong>Moisturizers are major component of basic daily skin care in patients with eczema/dermatitis. Botanical ingredients like aloe vera extract having anti-inflammatory property can be useful in reducing signs and symptoms along with improvement in dry skin in such patients.</p><p class="abstract"><strong>Methods: </strong>It was retrospective data analysis conducted across 145 centres in India. Patients with eczema/dermatitis who were prescribed Elovera a novel plant-based moisturizer were included in the study. Effectiveness was assessed by evaluating improvement in DASI score, physicians, and patients’ global assessment of disease. Safety was assessed by monitoring all the adverse events reported by the patients.</p><p class="abstract"><strong>Results:</strong> 402 patients were included in the study. There was significant improvement in mean baseline DASI score with with a reduction of 40.57% and 84.8% at week 2 and week 4, respectively. 86.31% (n=347) and 85.32% (n=343) patients reported significant improvement in their disease as per physician’s and patients’ global assessment of disease. Elovera was well tolerated and only 5 patients reported mild irritation and erythema during treatment.</p><p class="abstract"><strong>Conclusions: </strong>The result of our study proves that “Elovera” a novel plant-based moisturizer is associated with significant improvement in dry skin, signs, and symptoms of patients with eczema/dermatitis. Based on these results concomitant use of Elovera can be considered along with standard treatment for better outcome in patients with eczema/dermatitis. </p>

Fox sign in a case of terminal stage pancreatic cancer and suggestions for diagnosis

Skin signs in acute pancreatitis are well-known and frequently discussed manifestations accompanied by unfavorable prognoses although they may rarely appear in clinical and forensic medicine. In 2018, the district attorney’s office ordered a forensic autopsy for a 74-year-old man with terminal stage pancreatic cancer. The autopsy was ordered based on accusations of the deceased’s widow regarding alleged medical malpractice and poor hospital care. The widow filed a grievance about multiple unsuccessful attempts to draw blood from her husband in addition to a diaper dermatitis at the right groin. An autopsy and additional histological examinations were performed. After considering all findings, the diaper dermatitis was eventually assumed to be a Fox sign caused by acute pancreatitis, and the allegations of medical malpractice were refuted. This case led us to identify another case with suspected cutaneous manifestations in pancreatic disease. We performed immunohistochemical staining on those two cases and six control cases to examine whether there was detectable presence of pancreatic lipase and trypsin in the skin discolorations and whether it could be used as a feasible method to verify skin signs associated with pancreatitis. Based on our findings, a minor disseminated lipase and trypsin staining should be considered regular and is therefore not conclusive of a skin sign associated with pancreatitis. Moreover, trypsin does not seem to be as suitable as lipase for this suggested immunohistochemical method. Nevertheless, this method might be a useful addition for determining the origin of skin discoloration and verifying skin signs associated with pancreatitis.

Idiopathic Inflammatory Myopathies (IIMs)

Diagnosis of inflammatory myopathy are usually based on clinical examination and histopathology of the muscles and muscle biopsy, usually guided by PET-CT. This is not uncommonly presented by extramacular signs like interstitial lung disease, dysphagia, few skin signs, loss of weight, arteritis, cardiomyopathy, Pulmonary hypertension, respiratory failure, and cancer.

Evaluation of early skin or laryngeal reaction at oral food challenge

Background: An oral food challenge (OFC) is required for diagnosing food allergies; however, uncertain reactions can impair the determination of when to stop the test. We aimed to determine the associations between immediately occurring mild allergic skin signs/laryngeal symptoms and positive OFC results. Methods: We retrospectively included children (aged 6 months to 15 years) who underwent open OFC for hen’s egg (HE), cow’s milk (CM), or wheat at a single centre between May 2012 and March 2020. Participants with mild skin signs or laryngeal symptoms at OFC initiation were classified as “skin” or “laryngeal” cases, respectively. Using logistic regression, the risk of positive OFC results, in a skin or laryngeal case, was assessed using univariate and multivariate analyses. Age, sex, total target dose, and serum levels of total and food-specific immunoglobulin E were used as covariates in prediction models. Results: In total, 2954, 1126, and 850 tests for HE, CM, and wheat, respectively, were included and comprised 115 (4%) and 25 (0.9%), 92 (9%) and 24 (2%), and 7 (1.3%) and 0 (0%) skin and laryngeal cases, respectively. Children with reactions to both HE and CM had a higher risk of a positive OFC than controls (odds ratio [95% confidence interval]: 4.6 [3.3–6.4], 2.9 [2.0–4.1] and 6.5 [3.0–10.9], 4.9 [2.2–10.9], respectively). Areas under the curves of prediction models ranged from 0.61 to 0.71. Conclusions: Uncertain reactions immediately after test initiation could not robustly predict OFC results, indicating the OFC could be continued under careful observation.