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Exploring Environmental Triggers and Viral Associations in a Case of Severe Bullous Pemphigoid
Full text linkBullous pemphigoid (BP) is an autoimmune disease characterized by pruritic blisters and plaques, primarily affecting elderly individuals. The etiology of BP is multifactorial, with several documented triggers, the extent of which is currently unknown. This case reviews currently documented BP triggers and presents a case of severe and refractory BP, whose onset and progression raise suspicion for indoor pollutants and viral infection as inciting triggers. Our patient\u27s condition worsened despite standard therapy, highlighting the complexity of BP management. This case adds to the literature, teasing out BP pathogenesis and highlighting the complicated hospital treatment course for severe autoimmune blistering diseases
Starting a New Program: Asking Good Questions
No full textThis chapter suggests a process for developing a new family medicine residency program. It reviews the questions that one should be asking prior to starting the endeavor, to continually improve the program while in the process and to ensure sustainability. In starting a new program, commit to beginning well, armed with a roadmap, relevant questions, curious minds, a community-engaged and collaborative approach, a commitment to excellence, innovation, and continuous program improvement in the cultivation of compassionate, well-rounded family medicine physicians
Pelvic Fractures in Pregnancy: Multidisciplinary Management and Outcomes
Full text linkPelvic fractures during pregnancy, though rare, pose significant risks to maternal and fetal health, necessitating a multidisciplinary approach to management. These injuries are predominantly caused by high-energy trauma, such as motor vehicle accidents, and are associated with a high incidence of complications, including maternal hemorrhage, placental abruption, and preterm labor. Advances in diagnostic imaging, such as low-dose CT scans and MRIs, have improved diagnostic accuracy while minimizing fetal exposure to radiation. Similarly, biomechanically tailored surgical interventions and innovative treatment strategies, including minimally invasive fixation techniques, have enhanced maternal survival rates, reaching 95% when multidisciplinary care is implemented. Despite these advancements, challenges persist, particularly in resource-limited settings where disparities in access to care result in poorer outcomes. Ethical and medico-legal considerations further complicate management, emphasizing the importance of informed consent and balancing maternal autonomy with fetal well-being. This review highlights the critical role of public health initiatives, such as trauma prevention campaigns, and the need for innovation in diagnostics, therapeutics, and long-term care. Future research should prioritize addressing gaps in our understanding of long-term maternal and neonatal outcomes, particularly regarding reproductive health and quality of life. By integrating advanced technologies, fostering collaboration, and improving global access to care, clinicians can achieve optimal outcomes for both mother and child
Milia En Plaque Associated With Prayer-Related Frictional Changes
Full text linkMilia en plaque (MEP) is an uncommon dermatologic condition characterized by grouped milia on an erythematous plaque. Its underlying cause remains unclear, though various internal and external factors may contribute. We present the first reported case of MEP linked to prayer-related frictional changes. A 67-year-old South Asian male developed a well-demarcated plaque with agminated milia on his forehead at the site of chronic mechanical friction from prayer-related prostration. Histopathology revealed cystically dilated follicles and inclusion cysts without atypia. Surgical excision led to complete resolution without recurrence at two months, with an excellent cosmetic outcome. This case highlights not only a novel trigger for MEP but also suggests that surgical excision may be an effective treatment option for localized lesions, offering favorable aesthetic results. Awareness of mechanical factors in MEP pathogenesis may guide prevention and individualized management strategies
Impact of Antimicrobial-Impregnated Dressings on the Rate of Periprosthetic Joint Infections in Primary Joint Arthroplasty Surgeries of the Hip and Knee
Full text linkPeriprosthetic joint infections (PJIs), are a serious complication following total joint arthroplasty (TJA) of the hip and knee. Antimicrobialimpregnated dressings (AMIDs) are emerging as an adjunct measure to reduce microbial growth at the surgical site. This literature review examines the evidence regarding iodine and silver AMIDs in primary TJA of the hip and knee. Evidence indicates that use of AMIDs can be highly beneficial in high-risk infection patients, especially silver-based AMIDs to reduce the incidence of PJIs. Studies showed silver- and iodine-based AMIDs have comparable effects on healing wounds colonized by Staphylococcus aureus. There remains debate regarding the appropriate clinical setting to utilize AMIDs, as they are generally more expensive than traditional dressings. Multiple studies demonstrate the utility and cost-effectiveness of AMIDs in reducing the risk of PJIs, including one study estimated that using AMIDs, particularly with silver, could reduce the nationwide cost of PJIs from 125 million. Silver-impregnated dressings were more expensive than iodine (18.07 on average), but there is variability in costs and product availability depending on facility contracts, among other factors. More research is needed to investigate optimal composition of AMIDs, the appropriate patient populations to utilize AMIDs in, and if it is cost effective for routine use in primary TJA of the hip and knee