Background: Keratosis pilaris (KP) is cosmetically displeasing and psychologically distressing. Many treatments are being tried, but they have not been very effective. There is a need for the evaluation of newer therapeutic modalities. Aim: Evaluation of efficacy and safety of tacrolimus 0.1% ointment in KP. Methods: A prospective hospital-based interventional study was conducted on 60 KP patients who presented to our outpatient department between January 2017 and June 2018. All patients were advised to apply tacrolimus ointment 0.1% twice daily to the right arm and petrolatum ointment twice daily to the left arm, over a period of 4 weeks. The treated sites were assessed using the investigator's global assessment (IGA) scale and comparing patient satisfaction scores at baseline and at the end of the treatment. Clinical and dermoscopic pictures were taken at baseline and at the end of the treatment. Results: Fifty-one patients completed the study. The IGA mean score was reduced by 0.58 in the tacrolimus group, compared to 0.39 in the petrolatum group. Although there was a statistically significant improvement in each arm, the difference in improvement between the right and left arms was not significant. However, the patient satisfaction score was higher in the tacrolimus group. Dermoscopy showed an improvement in the absence of follicular hyperkeratosis and erythema. Conclusion: Tacrolimus 0.1% ointment is an alternative and safe treatment in the treatment of KP. It has shown moderately higher patient satisfaction as compared to petrolatum and was tolerated well.

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This meta-analysis aims to evaluate the possible association between human papillomavirus (HPV) and colorectal cancer development. The search strategy was a logic applied to specific descriptors linked to Boolean operators (AND/OR). The searches were made at the PubMed, Web of Science, and Scientific Electronic Library Online databases, between 2005 and 2017. A total of 2937 patients were included in the study, where 1562 (53.2%) diagnosed with colorectal carcinoma and 1375 (46.8%) control samples from tissues without carcinoma. In patients with colorectal carcinoma, HPV was detected in 424 (27.1%) samples, but in the remaining 1138 (72.9%) patients, there was no detection of this virus. Among patients with healthy tissue, 129 (9.4%) samples were positive to HPV and 1246 (90.6%) samples were negative for the virus, with a significant statistical difference between the two groups (P < 0.0001). By combining all the results from the included studies, it was observed that HPV-positive patients presented with six times more chance to develop colorectal cancer when compared to those HPV-negative (odds ratio [OR] =6.398; confidence interval [CI] 95% =3.025–13.533; P < 0.0001). Asia was the continent with the smaller probability to develop colorectal cancer, with three times more chances of the patients with HPV to develop colon and rectum carcinomas, although no statistic relevance was found (OR = 3.270; CI 95% =0.899–11.890; P = 0.0721). This meta-analysis showed a correlation between the HPV and the enhanced probability to develop colorectal carcinoma, highlighting geographic variations that show as important to public health.

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Background: Preprocedural anxiety is a common problem in patients undergoing surgery or an invasive examination. This study investigated listening to self-selected music on anxiety and physiological responses in patients before gastroscopy. Aim: The study was to explore the effects of listening to music on anxiety and physiological responses before gastroscopy. Methods: A pretest–posttest control group design was conducted, in which patients scheduled for gastroscopy in a medical center located in Taipei, Taiwan, were enrolled. The participants were randomly assigned to the music group (n = 100) or the control group (n = 100) by drawing lots. The music group listened to self-selected music with earphones for 15 min before the procedure. In contrast, the control group rested for 15 min. Blood pressure (BP), heart rate, respiratory rate, and anxiety level were measured immediately before and after the music intervention. Results: After adjusting for covariates, anxiety (P = 0.003) and respiratory rate (P = 0.01) significantly decreased in the music group than in the control group. However, no statistical difference in BP and heart rate changes was observed between the two groups. Listening to music could effectively reduce anxiety in patients who believed in the relaxing effects of music. Conclusion: Listening to self-selected music could effectively reduce the patients' anxiety and respiratory rate before gastroscopy, which could be recommended as a routine practice to alleviate patients' anxiety and physiological arousal before gastroscopy.

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Background: Procalcitonin (PCT) and C-reactive protein (CRP) are two common and practical biomarkers for various diseases. However, their roles in scrub typhus (ST) have not been extensively investigated. Aim: In this study, we compared the effectiveness of PCT and CRP levels and the PCT/CRP ratio and evaluated their predictive performance in the diagnosis of ST. Methods: Patients with acute febrile illness and suspected ST infection treated at our hospital between January 2015 and December 2016 were retrospectively evaluated. An indirect immunofluorescent assay was used to confirm the presence of ST. Documented information included initial clinical images and laboratory data including PCT or CRP. Receiver operating characteristic curve analysis with area under curve (AUC) identified the optimal PCT, CRP, and PCT/CRP ratio cutoff values for the diagnosis of ST. Results: Among 189 patients with acute febrile illness, 153 (89.9%) tested positive for ST. CRP and PCT level data were available in 168 (88.8%) and 42 (22.2%) patients, respectively. Thirty patients (15.9%) underwent both CRP and PCT tests. ST-positive samples contained significantly higher levels of PCT (P < 0.001) and CRP (P = 0.015) than those of the 36 non-ST samples. No difference was observed in the PCT/CRP ratio (P = 0.477). The optimal cutoff values were 0.27 ng/mL, 1.65 mg/dL and 0.036 for PCT and CRP levels and PCT/CRP ratio, respectively. PCT level showed the best diagnostic performance (sensitivity = 89.3%; specificity = 92.3%; AUC = 0.894; 95% confidence interval [CI] =0.753–0.925). Combining PCT and CRP levels based on the respective optimal cutoff points further improved the performance of ST diagnosis (AUC = 0.906, 95% CI = 0.894–0.923), with 89.5% sensitivity and 91.7% specificity. PCT level was positively correlated with liver enzyme levels, and acute hepatitis could be identified with high specificity (100%) using a cutoff PCT threshold of 0.36 ng/mL. Conclusion: PCT is useful in ST diagnosis, and pending conformation in future studies may reflect hepatic dysfunction at initial presentation.

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Takayasu's arteritis (TA) is also termed pulseless disease owing to the frequent occlusion of large arteries originating from the aorta and its major branches. It is an uncommon chronic inflammatory progressive idiopathic large vessel vasculitis with a predilection for young women of childbearing age group. Fatigue, malaise, and fever are the frequently encountered early symptoms of TA. Hemoptysis is not commonly seen as an initial presentation of TA. The subclavian artery is most commonly involved, and the disease is usually discovered accidentally owing to pulse asymmetry. In addition, pulmonary artery involvement is not common in TA. Here, we present a case of a young female presented to us with hemoptysis with pulmonary artery involvement with a de novo diagnosis of TA.

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Prostate cancers commonly metastasize to the pelvic lymph nodes and bones, but malignant pleural effusion rarely occurs. Prostate cancer lesions rarely cytologically mimic lymphomas. We present the case of a 70-year-old man with a history of chronic obstructive pulmonary disease and prostate cancer after hormone therapy, as well as a rare manifestation of pleural effusion. Chest radiography revealed a large amount of left pleural effusion. The cytological analysis of the pleural fluid purely consisted of single tumor cells, which were not immunoreactive to Nkx3.1 or prostate-specific antigen. This was initially misinterpreted as a lymphoma. However, a further pleural biopsy revealed immunoreactivity to Nkx3.1, suggesting metastatic prostate cancer. This study showed that cytology and further biopsy effectively distinguished between Gleason 5 prostate cancer and lymphoma in a patient with pleural effusion.

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Background: Maternal nutrition is linked to nutrient supply to breastfeeding infants. Aim: This study aimed to determine how maternal serum Vitamin D relates to serum calcium, phosphate, and Vitamin D of exclusively breastfeeding young infants. Methods: Mother–infant pairs practicing exclusive breastfeeding at a Nigerian tertiary hospital were recruited and characterized. Their serum 25-hydroxyvitamin D (25-OHD), calcium, and phosphate were analyzed and compared. Results: A total of 110 mother–infant pairs were recruited. Mean (standard deviation) ages for mothers and infants were 27.4 (5.0) years and 3.0 (1.4) months, respectively. Thirty-four (30.9%) mothers and 26 (23.6%) infants were Vitamin D deficient. Serum 25-OHD (39.5 [25.0] vs. 33.4 [19.5] ng/ml; P = 0.045) and phosphate (4.9 [1.6] vs. 4.4 [1.8] mg/dl; P = 0.031) were lower in mothers than infants. Maternal 25-OHD correlated positively with infants' 25-OHD but not with infants' serum calcium and phosphate. Conclusion: Unlike serum calcium and phosphate, optimal maternal serum Vitamin D is necessary to maintain appropriate amount of serum Vitamin D in exclusively breastfeeding infants.

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Background: Liver resection (LR) is considered the main therapeutic strategy for small hepatocellular carcinomas (HCCs) (<3 cm). Recently, the efficacy of complete response after radiofrequency ablation (RFA) in medium-sized HCCs (3–5 cm) has been proposed. Comparative analyses of LR and RFA in HCC patients with single or multiple nodules and tumor sizes ranging from 3 to 5 cm are lacking. Aim: The purpose of this study is to compare the long-term outcomes of 132 patients diagnosed with medium-sized HCCs between 2010 and 2017 who underwent LR (n = 72) or RFA (n = 60) and met the inclusion criteria. Methods: Data were retrospectively analyzed using a prospective database. The treatment-related outcomes and risk factors of overall survival (OS) and disease-free survival (DFS) were investigated using univariate and multivariate Cox regression analyses. Results: The hospital stay was shorter in the RFA group than in the LR group (5.4 days vs. 14.3 days, respectively; P < 0.0001). RFA was associated with fewer treatment-related complications. OS and DFS were better in the LR group than in the RFA group. Treatment modality and albumin and alpha-fetoprotein levels were predictors for OS, while treatment modality and tumor number were predictors for DFS. Conclusion: LR is an effective treatment for patients with medium-sized HCCs in terms of long-term outcomes (OS and DFS), while RFA may be used as an alternative treatment to LR with comparable OS.

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T-cell LBL (T-LBL) is a rare lymphoma subtype in adults, and it usually has a dismal prognosis compared to other subtypes of non-Hodgkin lymphoma. Here, we present a unique case of T-LBL with myeloproliferative disease. A distinct fusion gene of ZMYM2-FGFR1 translocation was detected through next-generation sequencing, and this might be correlated with the translocation of chromosomes 8 and 13 (t[8;13]). Her disease condition seemed to be refractory to multiple lines of chemotherapy. Her lymphoma finally achieved a complete remission after a matched related allogeneic hematopoietic stem cell transplantation.

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