Clinicians may encounter a variety of skin conditions that present with vesiculobullous lesions in their everyday practice. Pemphigus vulgaris, pemphigus foliaceus, IgA pemphigus, and paraneoplastic pemphigus represent the spectrum of autoimmune bullous dermatoses of the pemphigus family. The pemphigus family of diseases is characterized by significant morbidity and mortality. Considering the risks associated with a delayed diagnosis or misdiagnosis and the potential for overlap in clinical features and treatment, evaluation for suspected pemphigus disease often requires thorough clinical assessment and laboratory testing. Diagnosis is focused on individual biopsies for histopathology and direct immunofluorescence. Additional laboratory methods used for diagnosis include indirect immunofluorescence and enzyme-linked immunosorbent assay. Recent advancements, including anti-CD20 therapy, have improved the efficacy and reduced the morbidity of pemphigus treatment. This contribution presents updates on the pathophysiology, clinical features, diagnostic work-up, and medical management of pemphigus. Improved strategies for diagnosis and clinical assessment are reviewed, and newer treatment options are discussed.

Background: Negative symptoms of schizophrenia have been demonstrated to be due to decreased dopamine in the mesocortical pathways. Stimulant medications are a class of medications that can increase dopamine activity in the mesocortical pathway. Case Presentation: We present the case of a patient whose negative symptoms improved from a Positive and Negative Syndrome (PANSS) score of 39 to 11 on the negative symptoms subscale during a three-week trial of dopamine agonist augmentation of antipsychotic therapy. The score on the positive symptoms subscale on PANSS remained low with a two-point reduction at the end of the three-week period. Conclusion: The potential benefits of using stimulant medications in treating negative symptoms of schizophrenia are discussed.

The aim of the present research is to study different protein fractions in sera of children and adolescent with  β –thalassemia major and minor and to compare the results with that of healthy control.One hundred fifty children and adolescents were enrolled in this study,including 50 patients with β- thalassemia major , 50 patients with  β- thalassemia minor as pathological control group and another apparently 50 healthy individuals as a control group. The age of all studied  groups ranged from (4-18)years.Total protein, albumin and immunoglobulins were estimated in sera of all subjects.  A Significant  decrease  was  found  in  the  total  protein and  albumin  levels  in sera  of both major and minor thalassemic patients  compared to normal groups. A Significant  increase  in  immunoglobulin  levels  (IgG, IgM and IgA) was found in the sera of major and minor   Î²-thalassemia patients compared to control.Different protein parts in sera of all subjects were detected  using cellulose acetate electrophoresis.The results revealed   significant  reduction in  β- globulin fractions  in    β- thalassemia major patients compared  to the normal  and pathological control groups. Significant elevations in γ- globulins fractions were observed in both major β- thalassemia and minor β- thalassemia  as compared to normal control group. As a Conclusion the alteration in some protein parts occurred which is more obvious in major thalassemia patients compared to the normal and pathological control groups. Key words: Protein Parts , Elecrtrophoresis , β-Thalassemia

Background Electronic clinical support tools show promise for facilitating tobacco screening and counseling in adolescent well-care. However, the application of support tools in pediatric settings has not been thoroughly studied. Successfully implementing support tools in local settings requires an understanding of barriers and facilitators from the perspective of both patients and providers. Objective This paper aimed to present the findings of a qualitative study conducted to inform the development and implementation of a support tool for adolescent tobacco screening and counseling in 3 pediatric clinics in North Florida. The primary objective of the study was to test and collect information needed to refine a tablet-based support tool with input from patients and providers in the study clinics. Methods A tablet prototype was designed to collect information from adolescents on tobacco susceptibility and use before their well-care visit and to present tobacco prevention videos based on their responses. Information collected from adolescents by the support tool would be available to providers during the visit to facilitate and streamline tobacco use assessment and counseling components of well-care. Focus groups with providers and staff from 3 pediatric clinics (n=24) identified barriers and facilitators to implementation of the support tool. In-depth interviews with racially and ethnically diverse adolescent patients who screened as susceptible to tobacco use (n=16) focused on acceptability and usability of the tool. All focus groups and interviews were audio-recorded and transcribed for team-based coding using thematic analysis. Results Privacy and confidentiality of information was a salient theme. Both groups expressed concerns that the tool’s audio and visual components would impede privacy and that parents may read their child’s responses or exert control over the process. Nearly all adolescents stated they would be comfortable with the option to complete the tool at home via a Web portal. Most adolescents stated they would feel comfortable discussing tobacco with their doctor. Adolescent interviews elicited 3 emergent themes that added context to perspectives on confidentiality and had practical implications for implementation: (1) purity : an expressed lack of concern for confidentiality among adolescents with no reported history of tobacco use; (2) steadfast honesty : a commitment to being honest with parents and providers about tobacco use, regardless of the situation; and (3) indifference : a perceived lack of relevance of confidentiality, based on the premise that others will “find out anyway” if adolescents are using tobacco. Conclusions This study informed several modifications to the intervention to address confidentiality and introduce efficiency to well-care visits. The support tool was...

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