Purpose of Review Teledermatology holds promise as a tool to bridge distances and enhance access for populations that are underserved by conventional means of dermatologic care. This review delineates underserved populations and examines recent investigations of teledermatology for these populations. An analysis of the benefits and ongoing challenges for teledermatology for underserved people is presented. Recent Findings Many studies demonstrate enhancement of access dermatologic service particularly when using store and forward modes. Many countries and states within the USA are beginning to reimburse for teledermatology services. There is an inherent educational benefit to healthcare providers in using teledermatology systems. However, the recent published literature tends to spotlight successes and may not balance the picture with descriptions of real-world challenges including sustainability, burden shifting, and differing cultural, ethical, and legal contexts around the world. Summary Teledermatology for underserved populations is fast becoming a useful tool for enhancing currently limited access to dermatologic services. Health systems will need to apply this tool tailored to the unique needs of each locale. Follow-up studies will be key to demonstrate durability of successful models and to learn from program challenges.

OBJECTIVE:To report a case of severe lactic acidosis and hypoglycemia due to acute metformin intoxication in a dog.CASE SUMMARY:A female neutered Rat Terrier was presented for an acute onset of seizure-like episodes, weakness, and vomiting approximately 14 hours after ingestion of 198 mg/kg of metformin. The dog was found to be laterally recumbent, paddling, and unresponsive shortly before presentation. On physical exam, the dog was in hypovolemic shock and hypothermic. Blood work revealed severe lactic acidosis and hypoglycemia. The dog was volume resuscitated with intravenous crystalloids and dextrose, followed by a continuous infusion of intravenous fluids and dextrose, as well as administration of isotonic sodium bicarbonate. Repeat blood work showed minimal improvement of the hyperlactatemia for 3 hours despite resolution of hypovolemia and hypoglycemia followed by gradual improvement over the next 9 hours of hospitalization. High performance liquid chromatography/tandem mass spectrometry analysis showed markedly increased plasma metformin concentrations at 3.9 μg/mL. The dog was discharged from the hospital within 24 hours and showed no recurrence of clinical signs one year following discharge.NEW OR UNIQUE INFORMATION PROVIDED:Metformin-associated lactic acidosis and hypoglycemia is a severe complication in human patients, but has not been reported in veterinary medicine. Aggressive treatment with supportive care including IV fluids and dextrose administration resulted in resolution of the clinical signs in this patient. Metformin toxicosis should be considered in dogs with severe hyperlactatemia and hypoglycemia of unknown etiology.

The ability to efficiently and reliably transfer genetic circuits between the key synthetic biology chassis, such as Escherichia coli and Bacillus subtilis, constitutes one of the major hurdles of the rational genome engineering. Using lambda Red recombineering we integrated the thermosensitive lambda repressor and the lysis genes of several bacteriophages into the E. coli chromosome. The lysis of the engineered autolytic cells is inducible by a simple temperature shift. We improved the lysis efficiency by introducing different combinations of lysis genes from bacteriophages lambda, ΦX174 and MS2 under the control of the thermosensitive lambda repressor into the E. coli chromosome. We tested the engineered autolytic cells by transferring plasmid and bacterial artificial chromosome (BAC)-borne genetic circuits from E. coli to B. subtilis. Our engineered system combines benefits of the two main synthetic biology chassis, E. coli and B. subtilis, and allows reliable and efficient transfer of DNA edited in E. coli into B. subtilis.

Background: Incidental focal fluorine-18-2-fluoro-2-deoxy-D-glucose (FDG) uptake in the thyroid is not uncommon. A significant proportion is due to intercurrent thyroid cancer on further evaluation.Purpose: To investigate and discuss the clinical significance and management of incidental focal FDG uptake in the thyroid gland on positron emission tomography/computed tomography (PET/CT) in patients with non-thyroidal malignancy.Material and Methods: We investigated 188/7896 (2.4%) patients who had incidental focal thyroid uptake on FDG PET/CT in an oncology population over a 45-month period. Diagnosis was confirmed in 63 patients of whom 59 patients had histopathological verification.Results: Thirty-two percent of confirmed cases were malignant comprising intercurrent thyroid cancer in three-quarters of these patients. Maximum standardized uptake values of the thyroid lesions and SUV ratios compared with background thyroid and mediastinal uptake were not predictive of a benign or malignant etiology. In patients with incidental thyroid cancers, more than half had non-papillary and intermediate to high-risk pathology.Conclusion: Focal FDG uptake in the thyroid gland on PET/CT showed a malignancy risk of 32%. The intensity of uptake does not predict histology and underpins the importance of further investigations to exclude intercurrent thyroid cancer in suitable patients.

F18–2‐fluoro‐2‐deoxy‐D‐glucose (FDG) positron emission tomography (PET) has become a well established tool in staging and assessing therapy response in lymphoma. Incidental thyroid uptake on PET is not uncommon and can pose a diagnostic and management challenge. We retrospectively evaluate the prevalence and clinical significance of incidental FDG uptake in the thyroid gland in patients with lymphoma. 1868 lymphoma patients underwent PET and PET‐CT between August 2002 and August 2008. 52 patients (2.8%) demonstrated FDG thyroid uptake (M = 17, F = 35; mean age 63 yr). Thyroid uptake was determined as focal or diffuse, maximum standardized uptake values (SUVmax) recorded as well as SUV max ratio compared to background mediastinum activity (SUVR). Corresponding CT findings on PET‐CT were evaluated independently. Results were correlated with clinical, histopathological and imaging follow‐up. 30 (1.6%) patients had focal thyroid uptake. 16 (53%) had histological confirmation either by surgery (n = 7) or FNA under USS (n = 9). The final diagnosis was benign in 12/30 patients and malignant in 9/30. The malignancy risk for focal thyroid uptake was 30%. Five patients had intercurrent thyroid cancer (four papillary, one microinvasive follicular) and four had lymphomatous involvement. There was no significant difference between the mean sizes of benign (23.7 mm, range 12–34) and malignant nodules (23.6 mm, range 8–48). The mean SUVmax of malignant and benign nodules was 4.4 (range 1.8–10.1) and 3.2 (range 1.8–6.9) respectively with no statistically significant difference. 22 (1.2%) patients had diffuse FDG uptake in thyroid and benign aetiology was found in all with adequate follow‐up (15/22). Focal FDG thyroid uptake on PET or PET‐CT in lymphoma patients warrants further investigations. The malignancy risk is 30% either due to intercurrent thyroid cancer or lymphomatous involvement. SUVmax, SUVR and CT attenuation characteristics are not helpful in distinguishing between benign and malignant aetiologies. Diffuse thyroid uptake has a benign aetiology. Copyright © 2010 John Wiley & Sons, Ltd.