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Background: Glabellar lines have social and psychological implication since oftentimes generate negative facial expressions that could be misunderstood, such as anger, anxiety, fear or sadness, and others related to extrinsic aging signs. Botulinum toxin type A has been used for more than 20 years in aesthetic medicine and one of many options to improve dynamic facial lines on upper third of the face, including glabellar lines. On April 2009. FDA approved abobotulinum toksin A (Dysport) as the latest botulinum toxin type A, a purified complex diluted with human serum albumin and lactose. Aim: The purpose of this study is to analyze the effectiveness of botulinum toxin type A (abobotulinum toxin A) as a therapy for moderate to severe glabellar lines. Methods: searching the electronic database Pubmed-MEDLINE, Scopus, ProQuest, Cochrane library, ClinicalTrials.gov, and Google Scholar, found five articles (n=1.134) included in qualitative and quantitave analysis. Result: Metaanalysis showed the value of Q statistic was z value = 9,079 (p=0,000). Glabellar lines improvement according to Glabellar Lines Scale were more prominent in botulinum toxin type A injection group compared to control group on the 30th day after botulinum toxin type A injection (relative risk 23,007; CI 95%,11,692 – 45,274). The result of the overall metanalysis showed that glabellar lines severity in the group with botulinum toxin type A injection was significantly improved compared to control group. Conclusion: Botulinum toxin type A 50 U (abobotulinum toxin type A) is effective in significantly improving glabellar lines severity compared to placebo group

Background: Onychomycosis is the most prevalent nail disease, accounting to about 50% of all onychopathies. The diagnosis is still a challenge considering that the gold standard complementary test (direct microscopy and culture) may be false negative in many cases. Objectives: The study aimed to evaluate the role of dermoscopy in diagnosis of onychomycosis in comparison with scrap microscopic examination, mycological culture and histopathology and to detect how close the dermoscopic examination to the previous diagnostic findings. Patients and Methods: The present study included 20 patients suffered from onychomychosis and they were subjected to clinical, KOH microscopic, dermoscopic, mycological and histological examinations. Results: Jagged edge with spikes, longitudinal striations, distal irregular termination and ruin appearance are dermoscopic criteria of onychomychosis observed in 75% of cases. KOH examination was positive in only 20% of patients showing spores and hyphae. Culture was positive in only 35% of cases with M. canis, T. violaceum, T. rubrum, Chaetomium sp. and Scopulariopsis brumpt and there were no difference between the dermoscopic features caused by different organisms. The histologic evaluation showed found septate hyphea and blastoconidias within the amorphous keratin of the nail in 65%. Conclusions: Dermoscopy may be considered an easy, helpful, quite simple, quick and inexpensive technique for increasing the diagnostic accuracy of onychomycosis and could be a practical and effective diagnostic tool when mycology is not readily available. Mycology can, on the other hand, be avoided when nail dermoscopy fail to show any diagnostic sign of onychomycosis.

Background: Androgenetic alopecia (AGA) is the most common form of hair loss in men, wherein systemic androgen disorders and genetic factors lead to progressive miniaturization of hair follicles due to changes in the duration of hair growth cycle, characterized by shorter anagen phase and longer telogen phase, resulting in smaller, thinner, and less pigmented terminal hair. The main goal of treatment in AGA is to prevent the miniaturization process. The therapeutic options commonly used in the treatment of male AGA, such as topical minoxidil and oral finasteride, have yet to produce satisfactory results. Currently, many new therapeutic modalities are being developed for AGA, one of which is platelet-rich plasma (PRP). Multiple growth factors secreted by PRP are thought to support hair growth by prolonging the anagen phase, preventing apoptosis, delaying induction of the catagen phase, triggering angiogenesis and increasing follicular vascularization. Methods: A systematic literature search was performed using PubMed-MEDLINE, Cochrane library, Embase, AMED, Clinicaltrials.gov, dan WHO ICTRP with the search terms “platelet rich plasma” and (“male androgenetic alopecia” or “male pattern hair loss”). Eight RCT were included in the qualitative synthesis and seven of them were included in the meta-analysis. Results: The overall SMD in hair density was -0.889 (95% CI: -1.630 – -0.147, p

Background: Atopic Dermatitis (AD) is a chronic, recurring inflammatory skin disease affecting 15-30% of childhood population. Its standard management entails the right skin care, avoidance of triggers, and topical corticosteroid treatment. However, long term topical corticosteroid usage produces significant side effects. Pathogenesis of AD is mainly influenced by the response of one of the main immune cells, type Th2. In AD, a change of intestinal microbiome composition takes place, which influences gut-skin axis. Probiotics are living organisms, which when consumed regularly and in adequate amount, promotes health benefits for the host. Probiotics modulate the immune system and cytokine production, causing a balance in Th1 and Th2 immune responses. This also regulates intestinal and skin microbiome homeostasis in AD. Methods: Online database research is conducted in Pubmed-MEDLINE, Cochrane Library, ProQuest, EBSCOhost, and Scopus. Seven articles are included in qualitative analysis (n = 701), between which four (n = 473) are included in quantitative analysis. Results: SCORAD Index meta-analysis with random effect model shows heterogenity test of I2 = 73% (p=0.003). Standardized mean difference is found to be -0.42 with CI 95%, -0.76 to -0.08. This shows a significant decrease in SCORAD Index in probiotic group, compared to placebo (p=0.01). Meta-analysis of serum IgE with fixed effect model shows heterogenity test of I2 = 0% (p=0.71). The standardized mean difference of IgE is -0.03 with CI 95%, -0.24 to 0.17. This shows a non-significant decrease on IgE serum in probiotic group, compared to placebo (p=0.74). Meta-analysis of serum IL-4 with fixed effect model shows heterogenity test of I2 = 0% (p=0.76). The standardized mean difference of IL-4 is -0.16, with CI 95%, -0.35 to 0.02. The result shows a greater but statistically non-significant decrease of serum IL-4 in probiotic group, compared to placebo (p=0.09). Conclusion: Probiotic supplementation may reduce AD lesion severity,…

The metallic endoscopic clip was first described for hemostasis in 1975. [1] Endoscopic clips are now frequently used in non-variceal upper gastrointestinal bleeding, and have many different indications. [1] Most clips are not magnetic resonance imaging [MRI]-safe, and are contraindications to MRI. [2] The hemostatic clips usually spontaneously dislodge within 1 to 3 weeks after placement, but some case reports have shown that they can be retained for up to 2 years. [5] Hemostatic clips retention until ulcers healed could promote permanent endoscopic hemostasis of both severe ulcer hemorrhage and very severe hemorrhage related to inpatient ulcer bleeding. [3] Given the short retention time, most physicians rarely advise their patients to abstain from diagnostic procedures that would be contraindicated with a hemostatic clips placed, such as magnetic resonance imaging. [5] Two cases will be reported for retained clips more than 2 years with a review about risks for clip retaining, MRI compatibility, and retrieving retained clips.

Transportation infrastructure promotes the interconnection of production factors between regions and enhances the efficiency of land use, while land use patterns also have an impact on transportation development patterns and mixes. Although the development of different regions within megacities tends to be integrated, different transportation mixes and land inputs still bring differentiated dynamics to the development of the blocks. In order to explore the relationship between regional traffic conditions and land use efficiency, this paper investigates the traffic development conditions and land use efficiency of each district in Shanghai by using the traffic dominance degree model and the three-stage Super-SBM model, and explores the relevant role relationship between them by using the coupled coordination degree model. The results show that: (1) the central city has the highest traffic dominance, and the suburban areas, especially the distant suburban areas, have low traffic dominance; (2) the land use efficiency of the eastern area of Shanghai is significantly higher than that of the western area, and the land use efficiency of the southern area is higher than that of the northern area; (3) in terms of coupling coordination, the traffic development and land use efficiency of most districts are coordinated, but the degree of coordination varies greatly, with Huangpu District, Yangpu District, Pudong New Area, and Hongqiao District. Yangpu District, Pudong New Area and Hongkou District are at a high level of coordinated development, Chongming District and Changning District are at an uncoordinated development, and the rest of the districts are at a medium level of coordinated development.

Objectives: Studies have suggested that the prevalence of Internet Gaming Disorder (IGD) is higher among Asian populations. This study compared the prevalence and severity of IGD between English-speaking gamers and Chinese-speaking gamers. Correlates of IGD were investigated in the global sample. Methods: A total of 101 English-speaking gamers and 130 Chinese-speaking gamers were recruited via a social marketing campaign and participated in an online questionnaire. Results: The prevalence of IGD was 0.0% and 0.8%, respectively, among English-speaking gamers and Chinese-speaking gamers. Chinese-speaking gamers were more likely to deceive family members, therapists, or others because of the amount of gaming activity, and were more likely to have jeopardized or lost an important relationship, job, or an educational or career opportunity because of gaming activity. English-speaking gamers were more likely to own a dedicated gaming device, started video gameplay at a younger age, spent more hours weekly on gameplay, and were more likely to play games to escape or relieve a negative mood. Among the global sample, correlates of a higher level of IGD were: being males, being current students, spending more hours weekly on gameplay, having experienced anxiety in the past year, having a higher level of violence, and having less real-life social support. Conclusions: These results suggested that the prevalence of IGD is low and comparable between English-speaking and Chinese-speaking gamers. The two populations differed in certain diagnosis criteria of IGD and behavioral factors relating to gameplay. Psychosocial factors of IGD were observed among the global sample adjusting for the cultural background.

Population of older person are growing globally, in Africa and Nigeria. The WHO stated that this demographic change has implications on health care systems and on achieving sustainable development goals (SDGs) and universal health coverage (UHC). However, programs to adjust to population aging is still lacking in countries like Nigeria. This project proposal aims to implement and evaluate, with goal of scaling up, community geriatric program on achieving SDGs and UHC among older persons in Nigeria. Intervention approach will include home based management of older persons through seven geriatric case management processes, service provisions by trained case managers across four intervention domains, instituting and supporting health geriatric clinics and drug banks, enrollment of beneficiaries into national health insurance program and supporting system strengthening (on geriatric care) for service providers and hospitals. Data collection and entry will be done using expert data capturing tools and geriatric data management information system (GDMIS), while data analysis will be done through comparison of pre and post intervention indices. Review of literatures and anecdotal data show paucity of geriatric projects for care of older persons whose population is exponentially increasing in Africa. This project proposal that aims to implement and evaluate effect of a novel and innovative community health programs on achieving SDGs and UHC goals among older persons in Nigeria will share its result, conclusion, and recommendations, which will be disseminated for adaption and adoption for geriatric programing in the African context.

Objective: Today, with the availability of direct-acting antivirals (DAAs), the value of therapeutic patient education (TPE) in chronic hepatitis C needs to be redefined, as these drugs have made treatment simple. The study presented here in sought to define what role TPE plays today in hepatitis C management along with what factors are associated with such programs being used. Methods: We included 786 patients mono-infected with hepatitis C virus (HCV) who underwent treatment with DAAs. 284 of whom benefited from a TPE program (36.1%). The characteristics of HCV and how it was treated were compared retrospectively between TPE+ and TPE- patients. The TPE program was overseen by a nurse. Results: The following factors were associated with TPE on multivariate analysis: migrant status (OR=3.63, 95%CI: 2.24-5.96, p

Objective: to identify the main digestive manifestations related to SARS-CoV-2 in Togo and to determine their impact on the prognosis of the disease. Patients and method: This was a cross-sectional study with retrospective and prospective collection, with descriptive and analytical aims, conducted from May 1, 2020 to April 30, 2021 at the national center for the management of infectious diseases of Lome. Patients of both sexes and of any age, tested positive for SARS-CoV-2 by PCR on nasopharyngeal and oropharyngeal samples and hospitalized at the national center for infectious disease management of Lome were included in this study. Digestive manifestations were divided into gastrointestinal manifestations and hepatobiliary manifestations. The threshold of significance of the tests was retained for a p value less than or equal to 0.05. Results: out of 876 patients hospitalized during the study period, 215 presented with digestive manifestations, corresponding to a prevalence of 24.54%. the predominance was male, with a male/female sex ratio of 1.74. the mean age was 46.07+/-16.14 [02 months – 82 years]. gastrointestinal manifestations were found in 11.98% of cases. abdominal pain was the most frequent digestive symptom (15.35%). hepatobiliary manifestations were represented by cytolysis syndrome (44.19%) and cholestasis syndrome (36.28%). digestive manifestations were associated with renal failure (p=0.03) and thrombocytosis (p