INTRODUCTION

Diffuse cutaneous mastocytosis (DCM) is a rare and severe form of cutaneous mastocytosis which may present in the neonatal period; thus early recognition is essential. Symptoms of mastocytosis are exacerbated by mast cell degranulating agents more commonly from heat, friction, local trauma, drugs and food. This is a case of DCM presenting with bullous eruptions after immunization.

CASE REPORT

An 11-month-old boy presented with generalized erythematous to hyperpigmented macules and patches initially at birth, with progression to bullous eruptions immediately after immunization without any systemic symptoms. Biopsy revealed superficial and deep mixed cell infiltrates consisting of lymphocytes, histiocytes and numerous mast cells. Giemsa stain highlighted the metachromatic mast cell granules. Serum tryptase was elevated by 13 times (130 ug/L). The patient was prescribed oral antihistamines and topical steroids that offered good response. Avoidance of all potential triggers was instructed.

DISCUSSION

The extensive cutaneous involvement in DCM (generalized erythema, diffuse papules that develop pachyderma, darker skin, peau d’orange) are due to the diffuse infiltration of the dermis with mast cells, accompanied with an elevated serum tryptase.

Unique to this local case are exacerbations triggered by vaccination. There is literature to support evidence of vaccination reactions to pentavalent vaccine in children with DCM though the pathway associated with mast cell degranulation after immunization has not yet been specified.

It is advised that patients with DCM follow scheduled immunization guidelines with precautionary measures.

Human ; Male ; Infant: 1-23 Months ; Wounds And Injuries ; Research Report ; Pharmaceutical Preparations ; Mastocytosis, Cutaneous ; Hot Temperature

The spleen is a very hostile environment for tumor cells due to its anatomic location, blood supply, and rich immunological property – which makes it one of the most unique organ to be involved in metastatic diseases.15 Splenic metastases from non-hematologic malignancies are rare ranging from 0.6 to 7.1% base on autopsy reports of cancer patients, and 1.1 to 3.4% base on review of splenectomy cases.14 Moreover, isolated splenic metastases are more infrequent with only 31 cases reported from 1969 to October 2015.16 A splenic abscess is an unusual formation and is usually caused by hematogenous spread from an infection. Such expected frequency varies in different autopsy studies between 0.14% and 0.7%.1 Albeit rare, abscess can also result from migration of gut flora brought about by direct invasion of tumor cells from a neighboring neoplasm.17 This is a case of a 36-year-old female who came in with a history of abdominal pain, chills and fever for seven months. CT scan of the whole abdomen revealed splenic abscess with suspicion of a splenic rupture. The patient underwent exploratory laparotomy with abscess evacuation, splenectomy and double barrel colostomy and given with intravenous antibiotics. Histopathology results showed metastatic adenocarcinoma in the spleen. Thorough deliberation of her case was done and she was eventually managed as a case of Colon Cancer Stage IV and underwent chemotherapy. Splenic abscess developing from splenic metastasis from a colonic adenocarcinoma is rare and with concomitant high mortality rate. More often than not, splenic metastasis is discovered in advanced stage together with metastatic tumor in other organs while isolated splenic metastasis is even more uncommon. A splenic abscess as an initial demonstration of a colon cancer is not a common daily encounter of physicians hence a high index of suspicion coupled with sensitive and specific imaging is necessary in order to provide prompt medical and surgical intervention.

Human ; Female ; Adult: 25-44 Yrs Old ; Abdomen ; Adenocarcinoma ; Autopsy ; Colostomy ; Gastrointestinal Microbiome ; Pain ; Research Report ; Infections ; History ; Splenic Rupture ; World Health Organization ; Neoplasms ; Disease ; Fever ; Hematologic Neoplasms

The Remote Home Environment Assessment (RHEA) Framework is a guide designed to help therapists conduct structured home environment assessments remotely using tools and technology. It offers an efficient and practical approach to overcoming the limitations of facility-based home assessments. The framework offers step-by-step procedures for remote home environment assessment for adult clients with physical dysfunction. It involves four major steps that focus on assessing the client’s physical environment: a) screening for selecting the most appropriate remote home environment assessment modality/ies; b) a preparatory phase that includes signing consent forms, explaining the assessment process, and previewing preliminary information; c) administration of the remote assessment; and d) consolidation of the home information. Furthermore, supplementary materials such as screening form, client and health facility consent forms, home evaluation questionnaire and checklist, and client instructions were developed to facilitate and guide the implementing therapist through the aforementioned steps. Pilot testing is recommended to gain accurate and practical insights into the RHEA Framework’s usability and effectiveness.

Human ; Home Environment ; Occupational Therapy

Human ; Environment ; Work ; Philippines

OBJECTIVES

o demonstrate the utility of the supraclavicular artery island flap (SCAIF) as a viable alternative to free tissue transfer for reconstruction of large cervicofacial defects.

METHODS

Design:Case Report

Setting:Tertiary National University Hospital

Patient: One

RESULTS

A 43-year-old woman with a giant cavernous hemangioma measuring 21.43 x 9.91 x 20.75cm underwent tumor resection and immediate reconstruction using SCAIF. Following preoperative embolization and complete tumor excision, an 11 x 15cm cervicofacial defect was successfully reconstructed using SCAIF. The patient experienced post-operative complications including multiple wound dehiscences and hypertrophic scar formation but achieved significant functional and aesthetic improvement. At three months follow up, the patient reported cessation of bleeding episodes, improved feeding capacity, and enhanced quality of life despite persistent tracheostomy dependence. Plans for secondary surgery include scar revision, commissuroplasty, and intralesional steroid injections.

CONCLUSION

The supraclavicular artery island flap presents a practical, cost-effective alternative to free tissue transfer for extensive cervicofacial reconstruction, particularly in resource-limited environments or in patients where free tissue transfer is contraindicated. Advantages include good color match, wide arc of rotation, and ease of harvest. Despite potential complications, it offers excellent functional and aesthetic outcomes with acceptable donor site morbidity.

Human ; Female ; Young Adult: 19-24 Yrs Old ; Aids-related Complex ; Neoplasms ; Costs And Cost Analysis ; General Surgery ; Environment ; Research Report ; Steroids ; Tracheostomy ; Hospitals

BACKGROUND

Organizational commitment strengthens care delivery and system responsiveness, yet high turnover and workforce exhaustion threaten healthcare stability. Understanding factors that sustain commitment is especially critical during crises such as the COVID-19 pandemic.

AIM

This study examined how nurses' attitudes toward their practice environment predict organizational commitment at King Abdullah Medical City (KAMC), Makkah, Saudi Arabia.

DESIGN

Across-sectional predictive correlational design was used.

METHODS

Data was collected from 275 staff nurses between October and November 2020 using convenience sampling. Attitudes toward the practice environment were assessed with the Practice Environment Scale of the Nursing Work Index (PESNWI), while organizational commitment was measured using the Revised Three-Component Model Employee Commitment Survey. Descriptive statistics, Pearson's correlations, and multiple regression were conducted in SPSS version 21.

RESULTS

Nurses reported positive work attitudes, with the highest ratings for nursing care and interdisciplinary relationships, followed by management and leadership, and the lowest for adequate resources. Organizational commitment was moderate across affective, normative, and continuance domains. Regression analyses identified nursing care and interdisciplinary relationships as the most consistent predictor across all domains of commitment, including affective (p < .001), normative (p = .047), continuance (p = .004), and overall organizational commitment (p < .001). Adequate resources significantly predicted affective (p = .014) and overall commitment (p = .050), while management and leadership predicted normative commitment (p = .016).

CONCLUSION

Nurses' perceptions of their practice environment significantly shape organizational commitment during crisis conditions. Interdisciplinary collaboration consistently emerged as the strongest predictor, underscoring the value of teamwork and nurse–physician partnerships. Adequate staffing and resources also reinforced commitment, particularly in sustaining affective bonds. These findings underscored that supportive practice environments, through collaboration, adequate resources, and participatory leadership, enhance nurses' autonomy and sense of meaningful work, which in turn strengthen organizational commitment, retention, and resilience during crises.

Human ; Nurses ; Nursing ; Workforce ; Health Resources ; Covid-19 ; Work ; Leadership ; Environment ; Saudi Arabia

Objective To explore the mechanism by which She-Ti-Zhi-Qiu decoction alleviates allergic rhinitis (AR) through gut microbiota-mediated regulation of T helper cell 17(Th17)/regulatory T cells(Treg) balance and related cytokines. Methods Twenty-eight female SD rats were randomly divided into four groups: the Control group, Model group, STZQ group, and Probiotics group. Except for the Control group, all other groups were sensitized with ovalbumin (OVA) to establish AR models. The Control and Model groups received intragastric administration of normal saline, while the STZQ group was administered She-Ti-Zhi-Qiu Decoction, and Probiotics group received probiotics. After two weeks of continuous intragastric administration, nasal mucosa, serum, peripheral blood, and colon contents were collected. The inflammation of nasal mucosal tissue was assessed via HE staining. 16S rDNA sequencing was used to detect and analyze the structure and content of bacteria in colon contents. Flow cytometry was used to detect the relative proportions of Treg and Th17 cells in peripheral blood. ELISA was used to measure the levels of Th17- and Treg-related cytokines in serum. Results Compared with the Control group, the Model group showed an inflammatory response in nasal mucosal tissue, along with increased IL-17A and IL-17E levels and decreased IL-10 levels. The percentage of Th17 cells in peripheral blood increased, while the percentage of Treg cells decreased. Beneficial bacteria in the intestine were decreased, while pathogenic bacteria were increased. Compared with the Model group, the STZQ group showed lower serum IL-17A and IL-17E levels and higher IL-10 levels. The percentage of Th17 in peripheral blood decreased, while the percentage of Treg increased. There was an increase in beneficial bacteria in the intestine and a decrease in pathogenic bacteria. The changes in the microbiota were correlated with IL-17A, IL-17E, and IL-10 levels. Conclusion She-Ti-Zhi-Qiu decoction can ameliorate the inflammation of AR by regulating gut microbiota and Th17/Treg immune balance.
Animals ; T-Lymphocytes, Regulatory/drug effects* ; Th17 Cells/drug effects* ; Gastrointestinal Microbiome/drug effects* ; Rats, Sprague-Dawley ; Drugs, Chinese Herbal/therapeutic use* ; Female ; Rhinitis, Allergic/microbiology* ; Rats ; Cytokines

OBJECTIVES: To analyze the potential causal relationship between gut microbiota and food allergy (FA) using two-sample Mendelian randomization (MR) methods. METHODS: Data from genome-wide association studies on gut microbiota and FA were utilized. MR analysis was conducted employing inverse variance weighting, MR-Egger regression, and weighted median methods to assess the causal relationship between gut microbiota and FA. Cochrane's Q test was used to evaluate heterogeneity of instrumental variables, MR-PRESSO analysis was conducted to test for outliers and pleiotropy, and MR-Egger regression was employed to assess horizontal pleiotropy. The "leave-one-out" method was used to evaluate the impact of removing individual single nucleotide polymorphisms on the causal relationship. RESULTS: Inverse variance weighting analysis revealed that the phylum Verrucomicrobia, family Verrucomicrobiaceae, order Verrucomicrobiales, genus Ruminococcaceae UCG013, and genus Akkermansia were negatively associated with FA (P<0.05). Sensitivity analyses confirmed the reliability of the findings, indicating no heterogeneity or pleiotropy present. CONCLUSIONS There is a causal relationship between gut microbiota and FA, with Verrucomicrobia, Verrucomicrobiaceae, Verrucomicrobiales, Ruminococcaceae UCG013, and Akkermansia potentially reducing the risk of developing FA. These findings provide potential targets for the treatment and prevention of FA; however, further research is needed to explore the specific mechanisms by which the microbiota influence FA.
Humans ; Mendelian Randomization Analysis ; Gastrointestinal Microbiome ; Food Hypersensitivity/microbiology* ; Genome-Wide Association Study ; Polymorphism, Single Nucleotide

Bronchial asthma (asthma) is a complex inflammatory airway disease affecting approximately 100 million children worldwide, imposing a heavy burden on society and families. Studies have shown that the gut microbiota plays a significant role in the occurrence and development of childhood asthma. This paper reviews the research progress on the relationship between gut microbiota and childhood asthma. By elucidating the composition, function, and relationship with the host of gut microbiota, the impact of changes in its composition and function on the development of asthma is revealed. Furthermore, the potential value and application prospects of modulating gut microbiota as a new strategy for asthma treatment are discussed, providing a theoretical reference for in-depth research on the relationship between gut microbiota and the onset of childhood asthma and the development of new therapeutic approaches.
Humans ; Asthma/etiology* ; Gastrointestinal Microbiome/physiology* ; Child

OBJECTIVES: To investigate the effect of interleukin-17 (IL-17) gene polymorphism on the susceptibility to cow's milk protein allergy (CMPA) in infants and its association with gut microbiota. METHODS: A prospective study was conducted involving 100 infants diagnosed with CMPA at the Women and Children's Hospital of Ningbo University from January 2022 to October 2024. A total of 100 healthy infants undergoing routine check-ups at the same hospital during the same period was enrolled as the control group. Medical information was obtained through the electronic medical record system. IL-17A (rs2275913) and IL-17F (rs1889570) polymorphisms were detected using polymerase chain reaction-restriction fragment length polymorphism method. Serum IL-17 levels were measured using enzyme-linked immunosorbent assay, and high-throughput sequencing was employed to analyze the relative abundance of Lactobacillus and Bifidobacterium. Multivariate logistic regression analysis was used to explore the influencing factors of CMPA occurrence in infants. RESULTS: The proportions of infants with a family history of allergy and those with vitamin D deficiency or insufficiency were significantly higher in the CMPA group compared to those in the control group (P<0.05). The distribution of IL-17F (rs1889570) genotypes showed significant differences between the CMPA and control groups (P<0.05), with the frequency of the A allele being significantly higher in the CMPA group (P<0.05). Multivariate logistic regression analysis revealed that a family history of allergy, vitamin D deficiency or insufficiency, and carrying the IL-17F (rs1889570) AA genotype were independent influencing factors for CMPA in infants (P<0.05). Infants in the CMPA group with the IL-17F (rs1889570) AA genotype had significantly higher serum IL-17 levels compared to those with AG/GG genotypes (P<0.05), while the relative abundance of Lactobacillus and Bifidobacterium was significantly lower (P<0.05). CONCLUSIONS IL-17F (rs1889570) gene polymorphism influences susceptibility to CMPA in infants, potentially through mechanisms involving IL-17 expression and the relative abundance of gut probiotics.
Humans ; Interleukin-17/genetics* ; Milk Hypersensitivity/microbiology* ; Female ; Infant ; Male ; Prospective Studies ; Genetic Predisposition to Disease ; Gastrointestinal Microbiome ; Polymorphism, Genetic ; Milk Proteins/immunology*