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Kyrle Disease: A Systematic Review of Clinical Features, Diagnostic Approaches, Dermatoscopic Insights, Systemic Associations, and Therapeutic Strategies
No full textKyrle disease (KD) is a rare dermatologic condition characterized by hyperkeratotic papules with central keratotic plugs, often associated with systemic conditions such as diabetes and chronic kidney disease. Due to its clinical overlap with other dermatologic disorders, KD is frequently misdiagnosed. Diagnosis primarily relies on characteristic histopathological findings, with dermoscopy serving as a valuable adjunct for clinical assessment. This systematic review highlights KD\u27s clinical features, systemic associations, dermoscopy findings, differential diagnosis, and current treatment approaches. While some therapies have shown promise, the lack of standardized management underscores the need for further research. By consolidating the existing literature, this systematic review emphasizes the importance of a multidisciplinary approach in managing KD and calls for future studies to establish standardized diagnostic and therapeutic protocols to improve patient outcomes
The Analysis of Hospice Trends in the United States in 2020 Among Medicare Beneficiaries
No full textHospice care plays a critical role in the healthcare system, providing terminally ill patients comfort and symptom management. While hospice care has many benefits, there is variability among the service throughout the United States. This study examines variations in the average length of hospice care among Medicare beneficiaries, specifically focusing on how geographic location and primary diagnoses influence these outcomes. Through analyzing these differences, this research aims to identify potential disparities in hospice care and influence positive change in end-of-life care. Public hospice care data from data.cms.gov were analyzed to explore these trends. Findings indicate that Medicare beneficiaries in the South and West regions of the U.S. experience longer hospice stays, and in contrast, those in the Northeast and Midwest (including Alaska) reflected reduction from this average. Notably, states with shorter hospice durations showed a higher proportion of neoplastic disorders as the primary diagnosis, while those with longer stays showed an inverse relationship with greater prevalence of circulatory system disorders and lower incidence of neoplastic diagnoses. Additionally, the analysis reveals a consistent decline in average hospice length with increasing age among patients aged 80-85 across all U.S. regions, as expected. These findings highlight regional and diagnostic factors that contribute to variations in hospice care duration. Ultimately, this study highlights the need for comprehensive patient data and qualitative research to better address the disparities in end-of-life care delivery
The Western Dermatology Interest Group Association Conference: An Opportunity for Fostering Collaboration and Highlighting Student Research in Dermatology
No full textPatients Undergoing Hip Arthroscopy With Periportal and Puncture Capsulotomy Demonstrate Favorable Outcomes at Short-Term Follow-Up: A Systematic Review
No full textPurpose: To evaluate whether patients undergoing primary hip arthroscopy with periportal or puncture capsulotomy demonstrate improved patient-reported outcomes (PROs) at minimum 2-year follow-up when compared with preoperative PROs.
Methods: A systematic review was performed and registered in PROSPERO under ID: CRD42023466053. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus were searched in October of 2024 using the following string: (capsul∗ OR puncture OR periportal) and (hip OR femoroacetabular impingement) AND (arthroscop∗). Articles were included if they reported preoperative and minimum 2-year follow-up PROs in patients who underwent hip arthroscopy for the treatment of femoroacetabular impingement and/or labral tears with periportal or puncture capsulotomy and were written in English.
Results: Six studies were included, with 5 studies reporting outcomes on periportal capsulotomy (313 hips) and 1 study on puncture capsulotomy (163 hips). Three studies were Level IV evidence and 3 were Level III. Study periods ranged from 2013 to 2020. Average improvement in the modified Harris Hip Score ranged from 21.1 to 32.56 (I2 = 97%). Average improvement in the visual analog scale for pain ranged from -2.5 to -5.3 (I2 = 94%). Minimal clinically important difference was achieved by 65.0% to 100% of patients for Hip Outcome Score - Activities of Daily Living, 71.8% to 88% for Hip Outcome Score-Sport, and 62.5% to 78% for analog scale for pain. Three studies reported rates of secondary total hip arthroplasty, ranging from 0% to 1.7%.
Conclusions: Patients undergoing hip arthroscopy with periportal capsulotomy showed improvements in multiple PROs at a minimum of 2-year follow-up. Periportal capsulotomy appears to be an effective capsulotomy technique in patients undergoing hip arthroscopy for the treatment of femoroacetabular impingement and/or labral tears. Preliminary evidence shows puncture capsulotomy may be an effective way to access the capsule during hip arthroscopy, but conclusions are limited, given the lack of studies available
Efficacy of Amniotic Suspension Allografts in the Treatment of Knee Osteoarthritis: A Systematic Review
No full textKnee osteoarthritis significantly impacts mobility and quality of life. This condition is a leading cause of disability in aging populations, with total knee replacement commonly sought in advanced cases. Traditional nonoperative management strategies, including anti-inflammatories, corticosteroid injections, and hyaluronic acid, often provide limited relief, especially in severe cases. Recently, regenerative therapies such as amniotic suspension allografts (ASA) have emerged as promising alternatives due to their anti-inflammatory and regenerative properties, which may counteract the catabolic effects of osteoarthritis. This systematic review evaluated the efficacy and safety of ASA in reducing pain and improving function among knee osteoarthritis patients. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, a comprehensive search of PubMed and Embase databases initially identified 1,733 studies pertaining to ASA, of which 1,575 were screened, and 9 studies ultimately met the inclusion criteria for detailed analysis of ASA in the treatment of knee osteoarthritis. Data extraction and narrative synthesis focused on outcomes such as pain reduction and functional improvement using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), as well as safety profiles. The results demonstrated notable improvements in pain scores following ASA treatment, as shown by studies reporting increases in KOOS pain scores over 6 months, which generally outperformed hyaluronic acid and saline treatments in pain reduction. Similarly, ASA treatment was associated with substantial improvements in physical function outcome scores, enhancing patients\u27 ability to perform daily activities. Patient-reported outcomes also indicated higher quality of life and functional status, with most patients experiencing high levels of satisfaction. Additionally, ASA\u27s safety profile was favorable, with adverse events primarily mild to moderate in nature, including a few transient events such as knee stiffness and myalgias. This systematic review highlights ASA as an effective therapeutic option for knee osteoarthritis, although further studies focusing on long-term radiographic outcomes and mechanisms of action are recommended to fully establish its benefits and optimize treatment protocols
Functional Outcomes Reporting Using an Adjusted Outcomes Index for Mechanical Thrombectomy in Anterior Cerebral Artery Occlusions – A Case Series
Get PDFIntroduction
The decision to intervene with mechanical thrombectomy (MT) for anterior cerebral artery (ACA) strokes is often made based on anticipated long-term functional outcomes using modified Rankin scores (mRS) which is primarily based on ambulatory status. Here, we review our single-center experience with ACA MT and evaluate the utility of various functional outcomes reporting.
Methods
A case series of 15 patients undergone MT for ACA stroke using the Solitaire or Trevo stent-retrievers was completed. The data retrieved included patient demographics, initial National Institute of Health Stroke Scale (NIHSS), thrombolysis in cerebral infarction (TICI) scores and number of passes, post-procedure 24-hour NIHSS, intra-operative or post-operative complications, discharge NIHSS and mRS, and 90-day mRS.
Results
There were 87 % favorable ACA TICI scores (i.e. 2B/C and 3) and 80 % first pass recanalization rate. The Solitaire 4 mm stent-retriever was employed in the majority of cases (60 %). No procedural complications were noted in 73 % of cases and no hemorrhagic conversion in 87 % of cases. 90-day mRS scores of 0–2 were noted in 26 % of patients. Using an adjusted outcomes index, 80 % of patients had favorable outcomes based on the 24-hour baseline-adjusted NIHSS score decrease of ≥41 %.
Conclusion
Our preliminary findings here highlight successful radiographic and favorable functional outcomes using the Solitaire and Trevo stent-retrievers (3–6 mm luminal diameter) for ACA MT when reporting with the adjusted outcomes index as compared to the 90-day mRS score. Further studies comparing these outcomes reporting metrics with a larger sample size will be needed to further elucidate this notable difference
Carnivore and Ketogenic-like Diets: Proposed Alternatives for Mitigating and Treating Pediatric Obesity
Get PDFThe etiology of the rapidly evolving prevalence of pediatric obesity and diabetes is largely, if not entirely, due to the accessibility and affordability of whole foods and a lack of physical activity. Another likely large factor is health literacy. There is a lack of understanding that overconsumption of highly processed foods and a lack of exercise can lead to diseases even in childhood. Although the etiology of pediatric obesity is vastly multifactorial, diet is a crucial contributing factor, and this is the foundation of our research. This study investigates and compares the proposed efficacy of utilizing carnivore or ketogenic-like diets in treating pediatric obesity and other comorbidities. Current standard guidelines include recommending diets low in protein and high in vegetables, whereas participants implementing our proposed diets would prioritize protein intake. Although there are limited long-term data regarding carnivore or ketogenic-like diets, our research suggests that even short-term application of such a lifestyle will treat and likely prevent many cases of pediatric obesity. Regular physical activity is also encouraged to maximize the benefits of these diets, along with maintaining a mindful diet after the eventual cessation of these treatment diets. These diets have been shown to treat many conditions and show great promise in being realistic alternatives and preventative mechanisms to combat the epidemic of pediatric obesity
Chapter 17 - Vaccine-Based Immunotherapy for Pancreatic and Colon Cancers
No full textGastrointestinal (GI) cancers comprise about a quarter of all cancer cases, and the incidence of these cancers has consistently risen in recent years. Common risk factors for GI cancers include smoking, alcohol consumption, obesity, and infections. Immuno-checkpoint inhibitors like cytotoxic T-lymphocyte-associated antigen four antibodies show promise, however only benefitting a fraction of patients prompted to explore additional strategies for cancer immunotherapy. Cancer vaccines, originally designed for infectious diseases, stimulate immune responses, offering potential in cancer treatment, particularly for cancers like colorectal and pancreatic cancers. Several vaccines are tested and currently in testing using both preclinical experiments and clinical trials. Further research is needed for sophisticated vaccine technology, and the development of precision-based vaccines holds promise for preventing and treating GI cancers. Cancer vaccine research is progressing rapidly, addressing limitations and offering hope for precise vaccine development