The abnormal growth of skin cells often leads to skin cancer due to the exposure of skin cells to the sun. The skin disease is primarily caused by bacteria, fungus, viruses, UV radiation, and chemical substances. Generally, clinicians have been a trouble to categorize melanoma, seborrheic keratosis and lupus Erythematosus diseases due to the resemblance in the features of pigmented diseases. The paper presents an integrated approach for detecting the skin lesion from the dermoscopic images. The proposed integrated cumulative level difference mean (CLDM) based modified ABCD features and Support vector machine (SVM) have used for the detection and classification of skin lesion images. The proposed modified ABCD features employed for extracting the skin features like shape, size, color, and texture from the skin lesion images. Prior to the classification method, the Eigenvector Centrality feature ranking and selection (ECFS) method has utilized for better classification. After the feature selection method, a skin lesion image is classified by the Support vector machine (SVM). The performance of segmentation has been assessed by evaluating the Jaccard Similarity Index (JSI), Dice similarity coefficient (DSC), sensitivity, specificity, and accuracy. The proposed SVM method classifies the three skin lesion classes and produces excellent classification results with the classification accuracy is 97%, specificity is 98%, sensitivity is 97%, JSI is 97% and DSC is 98% for melanoma, seborrheic keratosis, and lupus Erythematosus respectively. The proposed approach classifies the three skin lesion classes (melanoma, seborrheic keratosis and lupus Erythematosus) with high accuracy. The integrated method not only enhances the accuracy level but also delivers significant information for better classification.

Integration of modified ABCD features and support vector machine for skin lesion types classification

Objectives Emergency department (ED) patients with serious skin and soft tissue infections (SSTIs) are often hospitalized to receive intravenous (IV) antibiotics. Appropriate patients may avoid admission following a single-dose, long-acting IV antibiotic. Methods We conducted a preintervention versus postintervention design trial at 11 U.S. EDs comparing hospitalization rates under usual care to those using a clinical pathway that included a single IV dalbavancin dose. We enrolled adults with cellulitis, abscess, or wound infection with an infected area of ≥75 cm2 without other indications for hospitalization. Clinical pathway participants discharged from the ED received a 24-hour follow-up telephone call and had a 48- to 72-hour in-person visit. We hypothesized that, compared to usual care, the clinical pathway would result in a significant reduction in the initial hospitalization rate. Results Of 156 and 153 participants in usual care and clinical pathway periods, median infection areas were 255.0 (interquartile range [IQR] = 150.0 to 500.0) cm2 and 289.0 (IQR = 161.3 to 555.0) cm2 , respectively. During their initial care, 60 (38.5%) usual care participants were hospitalized and 27 (17.6%) pathway participants were hospitalized (difference = 20.8 percentage points [PP], 95% confidence interval [CI] = 10.4 to 31.2 PP). Over 44 days, 70 (44.9%) usual care and 44 (28.8%) pathway participants were hospitalized (difference = 16.1 PP, 95% CI = 4.9 to 27.4 PP). Conclusions Implementation of an ED SSTI clinical pathway for patient selection and follow-up that included use of a single-dose, long-acting IV antibiotic was associated with a significant reduction in hospitalization rate for stable patients with moderately severe infections. Registration: NCT02961764.

Pathway with single-dose long-acting intravenous antibiotic reduces emergency department hospitalizations of patients with skin infections.

Bacterial skin and soft tissue infections are among the most common bacterial infections and constitute a major burden for patients and healthcare systems. Care is complicated by the variety of potential pathogens, some with resistance to previously effective antimicrobial agents, the wide spectrum of clinical presentations and the risk of progression to life-threatening forms. More-efficient care pathways are needed that can reduce hospital admissions and length of stay, while maintaining a high quality of care and adhering to antimicrobial stewardship principles. Several agents approved recently for treating acute bacterial skin and skin structure infections have characteristics that meet these requirements. We address the clinical and pharmacological characteristics of the fourth-generation fluoroquinolone delafloxacin, and the long-acting lipoglycopeptide agents dalbavancin and oritavancin.

Current and future options for treating complicated skin and soft tissue infections: focus on fluoroquinolones and long-acting lipoglycopeptide antibiotics.

Novel therapeutic strategies such as the long-acting lipoglycopeptide antibiotics allow for the treatment and discharge of selected emergency department (ED) patients with Acute Bacterial Skin and Skin Structure Infections (ABSSSI), who require intravenous antibiotics and would otherwise be hospitalized. The COVID-19 pandemic highlighted the need to develop strategies that may reduce hospitalization. The telehealth approach has shown success in remote management of cellulitis patients and could aid in the remote follow up of overall ABSSSI patients. This article describes a study protocol for the telemedicine follow up of patients diagnosed with ABSSSI in the ED, requiring intravenous treatment, receiving a single dalbavancin dose, and directly discharged. A telehealth system for remote follow up is evaluated as well as the possible inclusion of point-of-care ultrasound for the appropriate diagnosis of ABSSSI. The study will be conducted in compliance with regulatory requirements; and all collected data will be kept strictly confidential and in accordance with all relevant legislation on the control and protection of personal information. Dissemination of the study protocol may help increasing knowledge and awareness on this topic, with the aim of optimizing patient management, reducing hospitalization and lower the impact on healthcare associated costs. 

Pravin K. Krishna

Papers

Identification of Clinical Characteristics Associated With High-Level Care Among Patients With Skin and Soft Tissue Infections.