Philadelphia College of Osteopathic Medicine
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Evaluation of chronic pyoderma gangrenosum, acne, and suppurative hidradenitis (PASH) syndrome and its effect on kidney function: A cadaveric study.
Full text linkINTRODUCTION
Pyoderma gangrenosum, acne, and suppurative hidradenitis (PASH) syndrome is a rare, hereditary autoinflammatory disorder characterized by the presence of all three dermatological conditions. While PASH syndrome has only recently been identified, there is growing evidence linking pyoderma gangrenosum to kidney dysfunction. However, the relationship between kidney impairment and PASH syndrome remains largely unexplored. Understanding the potential impact of PASH syndrome on renal function is critical not only for advancing our knowledge of this rare condition, but also for improving patient management and treatment strategies. This case study aims to investigate the effect of PASH syndrome on kidney function through the examination of an 81-year-old male human cadaver.
METHODS
This is an observational cadaveric case study evaluating the impact of PASH syndrome on renal function. The study involved the dissection and anatomical analysis of an 81-year-old human cadaver with documented history of chronic PASH syndrome, exhibiting all three dermatological conditions. Each of the human cadavers’ kidneys were dissected to assess structural abnormalities and signs of pathology. Tissue samples from both kidneys were collected and preserved for histological analysis conducted at Colquitt Regional Medical Center. Renal morphology and presence of interstitial fibrosis, glomerulosclerosis, inflammation, or other pathological findings were considered as indicators of kidney dysfunction. Kidney morphology was compared to anatomical norms and previous research evaluating kidney changes associated with autoinflammatory disorders.
RESULTS
The examination of the 81-year-old human cadaver with confirmed PASH syndrome revealed several notable findings relating to kidney structure and signs of pathology within each kidney. Upon dissection, each kidney was of normal size compared to anatomical norms. A large renal cyst was identified on the renal capsule of the left kidney. The cyst was unilocular with a smooth surface. No immediate signs of rupture or infection were present. The right kidney did not show any significant macroscopic abnormalities. The histological examination of kidney tissues demonstrated the presence of interstitial fibrosis, sclerosis of the glomeruli, and increased inflammatory cells, which are all indicative of kidney dysfunction.
DISCUSSION
This cadaveric study provides evidence that PASH syndrome impacts kidney function, as demonstrated by the histological changes observed in the kidneys of the 81-year-old human cadaver. The presence of significant interstitial fibrosis, glomerular sclerosis, and increased inflammatory cells suggests that PASH syndrome may lead to kidney dysfunction. The findings demonstrate the potential for progressive renal dysfunction in individuals with this rare autoinflammatory disorder. Future studies involving a larger sample size and clinical evaluations are essential to confirm these findings and explore potential treatment methods aimed at preserving kidney function in individuals with PASH syndrome
Promoting Perinatal Mental Well-being: Empowering Healthcare Professionals
Full text linkThis pilot study aimed to address the critical need to enhance healthcare providers’ knowledge and shift their beliefs regarding perinatal mental health disorders through the development and implementation of a targeted educational workshop, “Promoting Perinatal Mental Health Well-Being”, designed to improve their understanding and attitudes toward identifying, treating, and supporting affected individuals. Using a qualitative approach, pre- and post-tests were administered to assess changes in knowledge and beliefs. While statistical significance was not achieved, likely due to a small sample size, prior training among participants, and other limitations, the findings revealed a meaningful shift in provider beliefs. Participants reported increased confidence in recognizing symptoms, initiating mental health discussions, prioritizing referrals, and incorporating brief interventions into clinical practice. The workshop also illuminated persistent systemic barriers, including stigma, time constraints, financial limitations, lack of culturally responsive care, and language obstacles. These factors contribute to the ongoing marginalization of perinatal mental health concerns and were identified as significant barriers to effective screening, referral, and treatment. Additionally, these findings underscore the critical role of provider beliefs in shaping patient outcomes and highlight the importance of integrating perinatal mental health education throughout all medical and health professional training levels. This study supports broader efforts to reduce stigma, promote early intervention, and improve health outcomes for perinatal individuals and their families by equipping providers with the insight and practical tools to deliver compassionate, proactive care
Insulinoma
No full textThis chapter reviews the topic of insulinoma which is considered to be the most common functional pancreatic neuroendocrine tumor (PNET). Patient presentation and workup will be reviewed along with consideration of differential diagnoses. The management of insulinoma will be discussed along with potential pitfalls. Additionally, and less well known, Insulinoma is the second most common PNET associated with type 1 multiple endocrine neoplasia (MEN) syndrome (10–15%). These tumors are usually small and require advanced localization yet larger tumors need to be evaluated for malignant potential
Deep Vein Thrombosis
No full textDeep vein thrombosis is the most common preventable cause of death in surgical patients. Early recognition of deep vein thrombosis and prompt treatment is critical in preventing progression of the disease and possible pulmonary embolism. Prevention of deep vein thrombosis in surgical patients is also critical, and the indications and contraindications should be well understood. The most common treatment for deep vein thrombosis is anticoagulation; however the indications for thrombectomy should be understood and recognized from a general surgery perspective
Opill (norgestrel): Where does the OTC birth control pill fit in among existing contraception?
No full textOral contraceptive pills have been a cornerstone of contraception for more than 6 decades. Oral contraceptives are highly effective in preventing unintended pregnancy, making them the most utilized reversible contraceptive method. Daily oral contraceptive pills have traditionally required a prescription from a healthcare provider due to potential risks and adverse reactions associated with use. The need for prescription creates significant barriers to accessibility and convenience for patients who may resort to less effective but more readily available nonprescription methods. Opill® (norgestrel) is the first and only FDA-approved daily oral contraceptive for over-the-counter use. This article examines Opill\u27s place in the current US contraceptive market
Wearable-Derived Heart Rate Variability Reveals Autonomic Dysfunction in Schizophrenia (Preprint)
Full text linkAutonomic dysfunction has long been implicated in schizophrenia, yet objective physiological markers remain underutilized in psychiatric research. Heart rate variability (HRV), a noninvasive measure of autonomic regulation, is conventionally derived from short electrocardiographic recordings. In this study, we tested whether continuous, wearable-derived HRV can identify physiologic alterations in schizophrenia-spectrum disorders. Using the NIH All of Us database, we analyzed second-level Fitbit heart rate data from 26 individuals with schizophrenia-spectrum diagnoses and 26 matched controls. Frequency-domain analyses focused on ultra-low frequency (ULF), very low frequency (VLF), and truncated low frequency (tLF) bands, given sampling constraints. Schizophrenia participants showed significantly reduced power across all bands (ULF p = 0.009; VLF p = 0.041; tLF p = 0.017), consistent with impaired autonomic regulation. These findings demonstrate that consumer wearables can detect dysautonomia in schizophrenia and highlight the potential of scalable digital biomarkers to advance psychiatric research and clinical care
The History of Cardiopulmonary Resuscitation and Where We Are Today
Full text linkCardiac arrest remains a leading cause of death worldwide and is a global health crisis. First described in the medical literature in the 18th century, modern cardiopulmonary resuscitation (CPR) with closed chest compressions has remained the standard of care since 1960. Despite exponential advances in basic science research and technological innovations, cardiac arrest survival remains a dismal 10%. The standard of care closed chest compressions provide only 20–30% of baseline cardiac output to the body. Have modern therapies plateaued in effectiveness? This article reviews the history of cardiac arrest, its therapies, and opportunities for future treatments. Through an exploration into the history of CPR and breakthroughs in its treatment paradigms, modern-day researchers and providers may find further inspiration to combat the cardiac arrest public health crisis
Perceived Knowledge and Confidence of Beta-Lactam Allergy Management Among Pharmacy Students on Advanced Pharmacy Practice Experiences.
No full textPharmacist engagement in allergy clarification has demonstrated increased appropriate antibiotic use. The purpose of this study was to determine the knowledge and confidence of pharmacy students in their final professional year regarding beta-lactam (BL) allergies. Students from 5 schools of pharmacy participated in a 22-question survey pertaining to experience with drug allergies, knowledge of BL allergies, and confidence regarding BL allergy management. Data were summarized among all respondents and further analyzed by infectious disease (ID) interest. A total of 160/521 students responded to the survey (31%). Most students (73%) had no course dedicated to drug allergies; however, 84% indicated the topic was taught within the curriculum. Students with an ID interest had a higher perceived knowledge regarding the details of penicillin skin testing (62% vs. 32%), clinical implications of penicillin skin test results (87% vs. 70%), and the principles behind a graded and direct penicillin challenge (64% vs. 41%). These students were more confident in educating patients about a perceived penicillin allergy (34% vs. 15%). Perceived knowledge and confidence of BL allergies were low, especially in high-level interventions. Targeted training in beta-lactam allergy recognition and management within the curriculum should be considered to improve upon these findings
Bundling Procedures in Critically Ill Trauma Patients: Should It Be Done?
No full textBACKGROUND: The precautions brought on by the COVID-19 pandemic led to the growing practice of bundling lines in patients requiring intubation. Our study aims to examine the effect of immediate bundled lines (IBL) on traumatic injuries. We hypothesized that severely injured patients may benefit from IBL.
METHODS: A retrospective review of all intubated trauma patients (1/2015-12/2020) at a Level I Trauma Center was conducted. Patients ≤18 years and those who died or were transferred prior to intensive care unit (ICU) admission were excluded. IBL was defined as placement of central venous catheter (CVC) and arterial line (AL) ≤4 hours after intubation. Delayed lines were any lines placed \u3e4 hours after intubation. Primary outcome was time from intubation to CVC and AL.
RESULTS: 728 patients were included. The majority received CVC and/or AL with 17.7% in a delayed fashion. Severe head injury (AIS ≥3) most often had immediate AL or delayed bundled lines (
DISCUSSION: Intubated trauma patients who presented with certain mechanisms (GSW, pedestrian struck), received blood transfusions, or exhibited severe/profound ISS may be more likely to receive IBL. IBL is not superior to either immediate AL or to no lines in terms of mortality. No lines had a significant effect on ICU LOS or hospital LOS, except in the setting of severe head injury
