Epidemiology and Screening for Melanoma.

Melanoma is the most commonly fatal type of skin cancer, and it is an important and growing public health problem in the United States and worldwide. Fortunately, incidence rates are decreasing in young people, stabilizing in middle-aged people, and increasing in older individuals. Herein, the authors further describe trends in melanoma incidence and mortality, review the literature on risk factors, and provide an up-to-date assessment of population-wide screening and new technology being utilized in melanoma screening.

Comparative Efficacy of Pharmacological Treatments for Acne Vulgaris: A Network Meta-Analysis of 221 Randomized Controlled Trials.

PURPOSE: Acne is an extremely common skin disease with an estimated global prevalence of 9.4%. We aim to provide comprehensive comparisons of the common pharmacological treatments for acne. METHODS: Randomized controlled trials comparing the efficacy of pharmacological therapies for acne vulgaris in patients of any age and sex and with a treatment duration of >2 weeks were included. PubMed and Embase databases were searched from inception until February 2022. Our prespecified primary end points were mean percentage reduction in total, inflammatory, and noninflammatory lesions. Treatment ranking was determined by P values. RESULTS: There were 210 articles describing 221 trials and 37 interventions included in the analysis. Our primary analysis of percentage reduction in total lesion count had 65,601 patients enrolled. Across all trials, the mean age was 20.4 years. The median duration of treatment was 12 weeks. The median total, inflammatory, and noninflammatory lesion counts were 72, 27, and 44, respectively. The most effective treatment was oral isotretinoin (mean difference [MD] = 48.41; P = 1.00), followed by triple therapy containing a topical antibiotic, a topical retinoid, and benzoyl peroxide (BPO) (MD = 38.15; P = .95) and by triple therapy containing an oral antibiotic, a topical retinoid, and BPO (MD = 34.83; P = .90). For monotherapies, oral or topical antibiotics or topical retinoids have comparable efficacy for inflammatory lesions, while oral or topical antibiotics have less effect on noninflammatory lesions. CONCLUSION: The most effective treatment for acne is oral isotretinoin, followed by triple therapies containing a topical retinoid, BPO, and an antibiotic. We present detailed comparisons of each intervention to serve as a practical database.

Outcomes of endoscopic retrograde cholangiopancreatography-guided gallbladder drainage compared to percutaneous cholecystostomy in acute cholecystitis.

Backgrounds/Aims: Endoscopic retrograde cholangiopancreatography-guided gallbladder drainage (ERGD) is an alternative to percutaneous cholecystostomy (PTC) for hospitalized acute cholecystitis (AC) patients. Methods: We retrospectively analyzed propensity score matched (PSM) AC hospitalizations using the National Inpatient Sample database between 2016 and 2019 to compare the outcomes of ERGD and PTC. Results: After PSM, there were 3,360 AC hospitalizations, with 48.8% undergoing PTC and 51.2% undergoing ERGD. There was no difference in median length of stay between the PTC and ERGD cohorts (p = 0.110). There was a higher median hospitalization cost in the ERGD cohort, $62,562 (interquartile range [IQR] $40,707-97,978) compared to PTC, $40,413 (IQR $25,244-65,608; p < 0.001). The 30-day inpatient mortality was significantly lower in hospitalizations with ERGD compared to PTC (adjusted hazard ratio 0.16, 95% confidence interval [CI]: 0.1-0.41; p < 0.001). There was no difference in association with blood transfusions, acute renal failure, ileus, small bowel obstruction, and open cholecystectomy conversion (p > 0.05) between hospitalizations with ERGD and PTC. There was lower association of acute hypoxic respiratory failure (adjusted ratio [AOR] 0.46, 95% CI: 0.29-0.72; p = 0.001), hypovolemia (AOR 0.66, 95% CI: 0.49-0.82; p = 0.009) and higher association of lower gastrointestinal bleed (AOR 1.94, 95% CI: 1.48-2.54; p < 0.001) with ERGD compared to PTC. Conclusions: ERGD is a safer alternative to PTC in patients with AC. The risk complications are lower in ERGD compared to PTC but no difference exists based on mortality or conversion to open cholecystectomy.

Sun protective behaviors in sun-sensitive individuals: a cross-sectional study examining for ethnic and racial differences.

The rates of non-melanoma skin cancer continue to rise in the United States. We investigated if differences exist in skin cancer preventive behaviors among sun-sensitive non-Hispanic whites and other racial and ethnic groups. The National Health Information Survey was used to perform the cross-sectional study. Outcomes of interest included multiple sun-protective methods. Individuals were determined to be sun-sensitive if Fitzpatrick skin phototype (SPT) I/II. Multivariable logistic regression was used to examine the associations between the use of sun-protective practices and race and ethnicity, SPT, and survey year. The study included 67,471 individuals. Adjusted prevalences of skin cancer preventive behaviors revealed that across all SPTs, non-Hispanic whites were more likely to use sunscreen, undergo physician-administered FBSE, and have multiple sunburns or tan indoors in the past year compared to corresponding SPT other racial and ethnic groups. In contrast, other racial and ethnic groups with any SPT were more likely to practice sun avoidance than corresponding SPT non-Hispanic whites. Additionally, other racial and ethnic groups with SPT III+ were more likely to wear sun-protective clothing than non-Hispanic white individuals with similar SPTs. For all SPT and racial and ethnic groups, there were significant increases in sunscreen use and decreases in past-year indoor tanning. Full body skin examination prevalence, regardless of sun sensitivity, increased for all non-Hispanic whites, but remained unchanged for sun-sensitive other racial and ethnic groups. Adjusted prevalence of multiple sunburns and use of protective clothing remained unchanged for all racial and ethnic groups across all SPT categories. There are differences in sun-protective behaviors among sun-sensitive individuals by race and ethnicity with the magnitude of some of these differences increasing. Future research and public health campaigns are needed on photosensitive individuals and the relationship between skin protective behaviors and race/ethnicity. When discussing sun protection, care providers should not only consider the influence of sun-sensitivity, but also race and ethnicity, and its impact on sun prevention behaviors.

Inpatient outcomes and racial disparities of palliative care consults in mechanically ventilated patients in the United States.

Intensive care units (ICUs) account for a disproportionately large share of healthcare utilization. Our study examined the association between palliative care consults (PCC) and hospital outcomes in mechanically ventilated patients. We analyzed patients admitted from 2016 to 2019 using the National Inpatient Sample database. The primary outcome was the association of PCC and length of stay; secondary outcomes included the impact of PCC on total hospital costs. Of the 2,351,503 patients included, 15.5% had a PCC, with a male predominance (53%, P < 0.001). Whites had a higher PCC rate, at 167 per 1000 ICU cases, vs. Blacks, at 25 per 1000 cases (P < 0.001). Adjusted length of stay was 2.0 days less in patients with PCC (P < 0.001), and adjusted inpatient hospital cost was $12,942 lower in patients with PCC (P < 0.001). Whites had a larger decrease in length of stay and costs compared to blacks, Hispanics, and Asians (P < 0.001). In conclusion, PCC was associated with a shorter length of stay and lower inpatient hospital costs in critically ill ICU patients. Black patients saw a lower impact of PCC on LOS and hospital costs, as well as a lower rate of PCC.

Comparative analysis and trends in liver transplant hospitalizations with Clostridium difficile infections: A 10-year national cross-sectional study.

GOALS AND BACKGROUND: Clostridium difficile infection (CDI) is the leading cause of antibiotic-associated diarrhea in the United States. We aimed to determine comparative trends in inpatient outcomes of liver transplant (LT) patients based on CDI during hospitalizations. METHODS: The national inpatient sample database was used to conduct the present retrospective study regarding CDI among the LT hospitalizations from 2009 to 2019. Primary outcomes included 10-year comparative trends of the length of stay (LOS) and mean inpatient charges (MIC). Secondary outcomes included comparative mortality and LT rejection trends. RESULTS: There was a 14.05% decrease in CDI in LT hospitalizations over the study period (p = .05). The trend in LOS did not significantly vary (p = .9). MIC increased significantly over the last decade in LT hospitalizations with CDI (p < .001). LT hospitalizations of autoimmune etiology compared against non-autoimmune did not increase association with CDI, adjusted odds ratio (aOR) 0.97 (95% confidence interval [CI] 0.75-1.26, p = .87). CDI was associated with increased mortality in LT hospitalizations, aOR 1.84 (95% CI 1.52-2.24, p < .001). In-hospital mortality for LT hospitalizations with CDI decreased by 7.75% over the study period (p = .3). CDI increased transplant rejections, aOR 1.3 (95% CI 1.08-1.65, p < .001). There was a declining trend in transplant rejection for LT hospitalization with CDI from 5% to 3% over the study period (p = .0048). CONCLUSION: CDI prevalence does not increase based on autoimmune LT etiology. It increases mortality in LT hospitalizations; however, trend for mortality and transplant rejections has been declining over the last decade.

Simple scoring for acute necrotizing pancreatitis: mortality in acute necrotizing pancreatitis during admission (MANP-A).

Background: Acute necrotizing pancreatitis (ANP) can result in a significant healthcare burden. The present study aimed to develop a new scoring system to accurately and promptly identify patients with a high likelihood of mortality to determine the need for aggressive measures. Methods: We retrospectively analyzed patients diagnosed with ANP using the National Inpatient Sample (NIS). The mortality in ANP during admission (MANP-A) scoring system was derived using multivariate Cox regression analysis and validated using receiver operating characteristic (ROC) curves in a validation cohort. Results: A total of 22,980 hospitalizations were identified in the derivation cohort. There was a predominance of males (65%) and white race (73%). Five variables showed significant association with mortality and were selected for developing the MANP-A scoring system: age ≥60 years; acute renal failure/kidney injury; sepsis with shock; vasopressor use; and disseminated intravascular coagulation. The MANP-A score has a maximum of 5 points and the cutoff for predicting mortality was set at 2 points. The area under the curve (AUC) using the ROC curve of the derivation cohort was 0.9195, 95% confidence interval [CI] 0.8838-0.9551 (P<0.001) for 7- and 0.8954, 95%CI 0.8723-0.9185 (P<0.001) for 30-day periods. The AUC of the Validation Cohort was 0.9204, 95%CI 0.8937-0.9469 (P<0.001) for 7- and 0.9059, 95%CI 0.8893-0.9223 (P<0.001) for 30-day periods. Conclusion: We propose a simple and objective score for predicting ANP inpatient mortality at 7- and 30-day intervals with high validity.

Ten-year trends and prediction model of 30-day inpatient mortality for alcoholic hepatitis in the United States.

Background: Alcoholic hepatitis (AH) results in significant morbidity, mortality and healthcare burden. We aimed to evaluate the temporal trends of AH hospitalizations in the last decade and to devise a mortality scoring system for risk stratification. Methods: National Inpatient Sample (NIS) databases from 2009-2019 were used to identify AH hospitalizations. Outcomes of interest included temporal trend analysis of length of stay (LOS), mean inpatient cost (MIC), mortality, and mortality predictors. A mortality scoring system was derived using multivariate Cox regression and validated using receiver operating characteristic curves. Results: There was an increase in total AH hospitalizations, from 67,070 in 2009 to 125,540 in 2019 (P=0.004). The inpatient mortality increased from 2.48% in 2009 to 3.78% in 2019 (P=0.008). The MIC was $31,189 in 2009 and $62,229 in 2019 (P<0.001). A trend for LOS was not significant. Ten variables were selected for incorporation into a risk score, including anemia, age >60 years, female sex, mechanical ventilation, vasopressor use, spontaneous bacterial peritonitis, hepatorenal syndrome, acute renal failure, coagulopathy (thrombocytopenia), and hepatic encephalopathy. The score has a maximum of eight points, and the cutoff for predicting mortality was set as 4 points. The area under the curve (AUC) of the derivation cohort was 0.8766 (95% confidence interval [CI] 0.865-0.888) and AUC 0.862 (95%CI 0.855-0.868) for a 30-day period. Conclusions: There has been an increase in AH hospitalizations and mortality in the last decade. The Tahira score provides an easy objective method to estimate inpatient 30-day mortality for AH hospitalizations.

Relation between inflammatory bowel disease, depression, and inpatient outcomes in the United States.

The relationship between inflammatory bowel disease (IBD) and depression is complicated. The effect of depression on ulcerative colitis (UC) and Crohn's disease (CD) among the inpatient US population has not previously been studied. We retrospectively analyzed patients admitted with UC and CD from 2016 to 2019 using the National Inpatient Sample database. Our primary outcome was the effect of depression on hospital length of stay (LOS), costs, and mortality. Secondary outcomes included the comparison between UC and CD cases. In the UC population, 13.4% had depression, compared to 14.9% in the CD population. LOS was longer in UC and CD patients with depression (P < 0.001). Subgroup analysis revealed that LOS was longer in CD patients than UC patients in the depressed cohort (P < 0.001). Inpatient hospital costs were lower in IBD patients with depression (P < 0.001). Subgroup analysis revealed that hospital cost was $17,974 higher in CD patients than UC patients (P < 0.001). Depression did not increase mortality in the IBD population but increased LOS, with a greater impact on CD than UC. White women were found to have an increased prevalence of depression in the IBD population.

Inpatient outcomes of Dieulafoy's lesions in the United States.

Dieulafoy's lesions are arguably underidentified rather than an infrequent cause of gastrointestinal bleeding. No population-based study exists regarding its inpatient outcomes in the United States. We evaluated the characteristics and inpatient outcomes for Dieulafoy's lesions using the National Inpatient Sample from 2016 to 2019. We identified 30,015 weighted hospitalizations for Dieulafoy's lesions. An initial diagnosis of Dieulafoy's lesions was established for 53.85% of patients on admission. The mean age was 68.7 ± 0.04 years, with male (56%) and white race predominance (70%). The mean length of stay and hospital cost were 7.87 days and $111,914, respectively. Significant predictors of inpatient mortality included heart failure, cardiac arrhythmias, coagulopathy, protein-calorie malnutrition, and alcoholism (P < 0.001). During inpatient hospitalization, 78% of patients underwent endoscopies, and 11% had colonoscopies. Inpatient mortality was 4.65%. Common comorbidities in Dieulafoy's lesions patients included heart failure (34%), cardiac arrhythmias (41%), hypertension (32%), chronic obstructive pulmonary disorders (25%), coagulopathic disorders (22%), and alcohol abuse (12%). Dieulafoy's lesions have a significant effect on length of stay and hospital cost. Endoscopies were used substantially more than colonoscopies for Dieulafoy's lesions, indicating a predominant presentation as upper gastrointestinal bleed. Cardiac disorders increase mortality in patients with Dieulafoy's lesions.

Epidemiology of Melanoma.

Please add expansion for AL. Melanoma is the most common fatal type of skin cancer and is an important and growing public health problem in the United States, Australia, New Zealand, and Europe. The mortality rate in most of the world has been rising as well, albeit slower than that for incidence. Likely due to the availability of new treatments for stage 4 melanoma, mortality rates in the United States dropped 18% from 2013 to 2016. We further describe trends in melanoma incidence and mortality, review the literature on risk factors, and provide an up-to-date assessment of population-wide screening and some of the inherent concerns.

An uncommon case of native joint septic arthritis by Parvimonas micra.

Parvimonas micra is an anaerobic, Gram-positive coccus found in the oral cavity and gastrointestinal tract. We report a case of a 77-year-old male with right knee pain after a recent dental procedure and fall. Arthrocentesis was notable for Parvimonas micra which was successfully treated with metronidazole.

Does one's geographic location influence their use of sun protection? A survey of 3,185 U.S. Residents.

To determine if geographical differences exist in practice of sun protective behaviors across the United States, we performed a retrospective, cross-sectional analysis of data from the Health Information National Trends Survey 4 Cycle 3. Self-reported sun protective behaviors and demographic information were collected for individuals from nine regions across the United States in 2013. Regions followed United States census divisions, including New England, Middle Atlantic, East North Central, West North Central, South Atlantic, East South Central, West South Central, Mountain, and Pacific. Study participants included 3,185 people from nine census regions. Sun protection was uncommonly practiced in the United States. The use of sunscreen in the West North Central region was the lowest sun protective practice. Long pants were more commonly worn in the West South Central and the Pacific. Sun protective behavior rates are low for all geographic locations across the United States. Future public health campaigns should place less emphasis on geographical influences of sun protective behaviors and focus more so on comprehensive, nationwide sun prevention campaigns.