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A bio-electric dressing improves post-deroofing outcomes in hidradenitis suppurativa by microbiome modulation: a split body, randomized clinical trial
No full textHidradenitis suppurativa (HS) tunnels represent treatment-resistant disease compartment that perpetuates inflammation, microbial dysbiosis, and relapse. Surgical deroofing remains the standard intervention, yet optimal post-operative wound management strategies are lacking.
We aimed to evaluate the efficacy of a wireless bioelectric wound dressing (BEWD) compared to standard of care (SOC) in modulating tunnel-associated microbiota and preventing surgical site recurrence following HS deroofing.
In this randomized, single center, split-body trial, patients with bilateral Hurley stage II–III axillary disease underwent tunnel deroofing, with one side randomized to BEWD or SOC (petrolatum and gauze dressing). Subjects (n=12) were followed for 8 weeks to assess primary outcomes - healing rates. Secondary outcomes included disease recurrence at week 8, change in bacterial load, microbiome composition, and quality of life.
BEWD-treated sites showed a significant reduction in bacterial load at weeks 2 and 4, post-excision with enrichment of commensals and a shift away from anaerobic taxa, not observed in SOC-treated sites. Minimal recurrences were observed on BEWD-treated sides alone compared to multiple recurrences on SOC- treated sites, with trends of improved healing trajectories.
Optimized wound care holds a potential to reduce surgical site recurrence and reverse HS dysbiosis. Our data emphasizes the importance of post-surgical care to improve outcomes in HS patients
Cytomegalovirus Lymphadenitis Mimicking Relapsed Lymphoma After CD19 Chimeric Antigen Receptor (CAR) T Cell Therapy
No full textEarly Vocal Development in TSC Predicts Language, But Not Autism Outcomes
No full textLanguage impairments impact 72% of individuals with Tuberous Sclerosis Complex (TSC). Nevertheless, evaluations are often delayed until children are 7 years old or older. Earlier prediction of language impairment is needed. Infant vocal behavior is a predictor of language development in typically developing (TD) children, but early vocal development had not been studied in TSC until recent research on 38 infants. In this study, the canonical babbling ratio (CBR) and volubility, key indicators of infant vocal behavior, were low. CBR reflects the proportion of syllables that are canonical, and volubility reflects either production of utterances or syllables per minute. The present study has three goals: 1) To expand CBR and volubility characterization, 2) To evaluate predictiveness of CBR and volubility for autism spectrum disorder (ASD) and language outcomes, and 3) To determine if the contribution of CBR to prediction is independent of other known predictors.
We analyzed 202 recordings at 12 months for infants with TSC. Linear regression predicted language outcomes from vocal measures. Then, stepwise multiple regression compared the relative predictiveness for language outcomes of CBR and other measures known to predict language outcomes. Finally, logistic regression tested for ASD prediction.
CBR and volubility were lower in TSC than in prior TD data. CBR was predictive of language outcomes at 24 months for infants with TSC even when competing against other known predictors, but neither CBR nor volubility predicted ASD.
CBR may have utility for early identification of language impairments in TSC.
•Canonical babbling ratio is low in children with TSC with and without autism spectrum disorder.•Canonical babbling ratio predicts language, but not autism outcomes in TSC.•Earlier recognition of language delays in TSC using canonical babbling ratio may lead to earlier intervention
Patient-Clinician Communication and Cardiovascular Outcomes: An Analysis of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), 2008-2019
No full textStrong patient-clinician communication may improve health outcomes for Hispanic/Latino individuals.
We assessed the association between patient-clinician communication and cardiovascular (CV) events or death in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).
HCHS/SOL is a longitudinal cohort study of individuals aged 18-74 who identified as Hispanic/Latino at 4 U.S. metropolitan areas. Participants' ratings of communication with clinicians during the year before enrollment were used to generate a 3-level communication score. The primary outcome was the composite of myocardial infarction (MI), heart failure events (HF), stroke, and all-cause mortality. The secondary outcomes included the components of the primary outcome. The association between the baseline communication score and outcomes of interest was assessed with Cox proportional hazards models adjusting for possible confounders. We also used multivariable linear regression to assess the cross-sectional association between communication and AHA Life’s Essential 8 (LE8), a measure of CV risk factors. All analyses accounted for the complex survey design.
Our sample included 10,527 individuals without prior CV events and at least one medical encounter in the year before enrollment. The median age at enrollment was 41 years (IQR 29, 53), 59% were female, and 71% perceived high-quality communication with clinicians. The mean follow-up time was 9.4 years. High-quality communication was associated with the following results in our fully adjusted analyses: composite outcome (aHR 0.73; 95% CI 0.51, 1.03; p = 0.073), CV events (aHR 0.82, 95% CI 0.44, 1.51, p = 0.520), all-cause mortality (aHR 0.54; 95% CI 0.37, 0.80; p = 0.002).
High-quality patient-clinician communication was associated with a non-significant trend toward a lower rate of CV events and death, driven by a significant association with lower all-cause mortality.
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Generalized Dystonia in a Patient With Wilson Disease 5 Years After Liver Transplant: A Case Report
No full textLiver transplant (LT) is considered curative for Wilson disease (WD) with hepatic failure refractory to medical therapy, particularly when neurologic symptoms are absent.
A 29-year-old man with WD developed progressive generalized dystonia five years after LT. He presented with acute-on-chronic neck pain, dysphagia, and dystonic posturing of the neck, trunk, and upper and lower extremities. MRI brain and copper studies were normal. Genetic testing confirmed two heterozygous pathogenic
variants. Symptoms improved with botulinum toxin injections.
Post-LT neurologic complications may arise from copper dysregulation, immunosuppressant neurotoxicity, or unrelated primary dystonia. Early recognition enables effective symptomatic management
Forging ophthalmology in Puerto Rico: Dr Ramón Emeterio Betances (1827-1898)
No full textRamon Emeterio Betances (1827-1898) stands out as a pivotal figure in the fields of ophthalmology and public health in nineteenth-century Puerto Rico. Trained in France, he returned to the island in 1856, where he treated cholera patients and introduced vital public health interventions. Known as 'The Physician of the Poor', Betances dedicated himself to serving marginalised populations, including enslaved individuals. He co-founded a secret abolitionist society and championed Puerto Rican independence, actions that resulted in multiple periods of exile. Together with his contemporaries, Betances helped lay the groundwork for ophthalmology in Puerto Rico, significantly advancing medical knowledge, improving public health infrastructure, and inspiring successive generations of clinicians. His enduring legacy is recognised for its profound medical, social, and political impact
Ocular Symptoms as a Marker of Dysautonomia in Long-COVID Patients: A Cross-Sectional Analysis
No full textBackground/Objectives: Post-coronavirus syndrome (long-COVID) refers to a multi-systemic range of symptoms that follows acute SARS-CoV-3 infection. Long-COVID has been linked with autonomic neuropathy as well as dry-eye disease (DED), an umbrella term that includes a variety of ocular symptoms and signs. Despite these associations, little is known about the co-occurrence of DED and dysautonomia symptoms in individuals with long-COVID. This study aims to examine relationships between dysautonomia and ocular symptoms in a long-COVID patient population. Methods: Cross-sectional study of 162 veterans with long-COVID. The Composite Autonomic Symptom Score-31 (COMPASS-31) assessed dysautonomia symptoms, and the NASA lean test and heart-rate variability metrics captured dysautonomia signs. Dry-eye disease (DED) symptoms were measured with the 5-Item Dry-Eye Questionnaire (DEQ5) and the Ocular Surface Disease Index (OSDI), while ocular pain intensity and neuropathic pain descriptors were evaluated using a Numerical Rating Scale (NRS) and select questions from the Neuropathic Pain Symptom Inventory modified for the Eye (NPSI-Eye), respectively. Results: Most participants (78%) reported DED symptoms (DEQ5 ≥ 6). Nearly all COMPASS-31 domains were associated with DED symptoms, with the strongest correlation observed between the OSDI and pupillomotor scores (r = 0.67, p < 0.001). Among the autonomic signs, the strongest associations were observed between the change in systolic and diastolic blood pressure from baseline to 8 min and ocular pain triggered by temperature (r = −0.44 and r = −0.48, respectively, p < 0.01 for both). On linear regression analyses, pupillomotor and secretomotor symptoms remained positively associated with DED symptoms, while autonomic signs were most closely related to ocular pain metrics, with fluctuating blood pressure changes during orthostasis relating to neuropathic symptoms. Conclusions: DED symptoms, including ocular pain intensity, relate to autonomic symptoms in a long-COVID cohort. While associations with autonomic signs were less consistent, these data suggest that subtle autonomic variability relates to ocular pain in the long-COVID setting
Neonatal Mimicry of Caregivers at Home: Feasibility of an Asynchronous Online Paradigm
No full textWhile early life sets the stage for later learning, comparatively less is known about newborns' cognition than that of older infants. A striking example is the lack of consensus regarding the extent to which newborns spontaneously mimic gestures, and whether such behavior drives bonding and learning. Despite the theoretical importance of these questions, practical challenges limit researchers' ability to engage newborns in behavioral research. Webcam-based, asynchronous online studies have expanded developmental science's capacity to reach older infants. However, such scalable and replicable methods have yet to be deployed with younger infants. Taking a commonly-used neonatal mimicry paradigm as a test case, we assessed the feasibility of leveraging an open-source online platform (Children Helping Science) for asynchronous research with 0-6-week-olds and their caregivers. Caregivers modeled face movements to their 4-45 days-old infants (N = 29, N = 17 included) while webcams filmed their infants' responses; 13 dyads participated more than once (72 included test videos). Preliminary evidence suggested that infants do not mimic caregivers' tongue protrusions (Bayes Factor ∼ ⅓). Data on the mimicry of caregivers' mouth openings was inconclusive (⅓ < BF < 3). Additional analyses identified a target sample size for future studies. Finally, we asked whether caregivers perceived their newborns' behavior as imitative. Caregivers' perceptions of mimicry reflected infants' behaviors but did not align with an often-used metric of mimicry ("imitators"). These results demonstrate the feasibility of asynchronous online behavioral studies with newborns and provide a foundation for future research on neonatal mimicry of caregivers
Comparing methods to measure wearable device adherence for physical activity monitoring for persons with autism: A prospective observational cohort study
No full textIndividuals with autism spectrum disorder (ASD) have higher rates of obesity and exhibit more sedentary behaviors than neurotypical peers. Use of wearable devices (WD) to target insufficient physical activity (PA) in this population has increased over the past decade. However, standardized methods for assessing WD adherence remain limited among this understudied population.
A prospective observational cohort design was used to compare two methods for determining WD adherence for monitoring PA in adolescents and adults with ASD.
Subjects were enrolled in an 8-week telehealth program aimed at improving PA among adolescents and adults with ASD. The Fitbit Inspire 3 WD was utilized for PA tracking and self-monitoring. Subject step activity and heart rate (HR) data were collected for an 8-week period via FITABASE management platform. Adherence was calculated using two methods. Method-A was defined as ≥10-hr daily wear-time based on HR monitoring; Method-B was defined as ≥ 500 steps/day. Observational data collected via researcher field notes documented participant-reported factors and/or behaviors that influenced WD adherence.
Data from twenty-seven subjects (21 males, 6 females) ages 14 to 28 years (mean: 18.85 years) were analyzed. Adherence was significantly higher when calculated using Method B (mean = 40 days, 5.4 weeks) compared to Method A (mean = 24 days, 2.8 weeks;
< .001). Observational data identified disability-related behaviors that negatively impacted Method A derived adherence.
Using HR-based measures of adherence may underestimate device use in individuals with ASD, potentially setting unrealistic expectations for continuous wear. Step-based metrics provides a more inclusive and pragmatic approach for assessing WD adherence in this population, with implications for future intervention design and evaluation. This study highlights the need to tailor WD adherence definitions to the behavioral and sensory profiles of neurodiverse populations. Further study is warranted