RESUMEN
Topical tacrolimus has been observed to induce granulomatous rosacea (GR) in prior case reports and series. In most cases, patients recover fully after withdrawing tacrolimus and initiating doxycycline or minocycline. Herein, we describe a case of severe GR, which required further therapy. Clinicians should be aware of this rare complication because of the frequent use of topical tacrolimus.
Asunto(s)
Antibacterianos/uso terapéutico , Rosácea/inducido químicamente , Tacrolimus/efectos adversos , Tetraciclina/uso terapéutico , Dermatitis Atópica/tratamiento farmacológico , Femenino , Humanos , Rosácea/tratamiento farmacológico , Tacrolimus/uso terapéutico , Adulto JovenAsunto(s)
Betacoronavirus , Infecciones por Coronavirus/mortalidad , Admisión del Paciente/estadística & datos numéricos , Neumonía Viral/mortalidad , Instituciones de Cuidados Especializados de Enfermería/estadística & datos numéricos , COVID-19 , Infecciones por Coronavirus/epidemiología , Humanos , Michigan/epidemiología , Ciudad de Nueva York/epidemiología , Ohio/epidemiología , Pandemias , Neumonía Viral/epidemiología , SARS-CoV-2RESUMEN
Complex regional pain syndrome (CRPS) is an incompletely understood disorder characterized by progressive regional pain and sensory changes, with fluctuating cutaneous edema and erythema. We describe a patient with a rarely reported severe bullous CRPS variant on the left lower extremity, which resolved immediately upon developing spinal paralysis.
Asunto(s)
Síndromes de Dolor Regional Complejo/terapia , Absceso Epidural/complicaciones , Paraplejía/microbiología , Adulto , Muñones de Amputación , Vesícula/etiología , Síndromes de Dolor Regional Complejo/complicaciones , Eritema/etiología , Femenino , Humanos , Dolor/etiología , Remisión Espontánea , MusloRESUMEN
BACKGROUND: Studies of dermatologic inpatients are important, given the rise in the number of admissions and of Medicare spending for dermatology-specific and dermatology-related diagnosis related groups (DRGs) in recent years. Yet inpatient studies of patients admitted for skin conditions have mainly focused on dermatology consults, which neglect the experiences of patients not seen by dermatology. Identifying patients based on DRG codes includes all patients admitted for skin conditions and therefore allows for a more comprehensive analysis of the dermatologic care delivered. OBJECTIVES: Our primary aim was to characterize the care of all patients admitted for a skin-related condition using dermatology DRGs. Our secondary aim was to assess the impact of a dermatology consult for those patients for whom a consult was called. DESIGN AND PARTICIPANTS: We conducted a retrospective chart review of 512 inpatient admissions assigned a dermatology-specific or dermatology-related DRG over fiscal year 2009 at an academic medical center in Boston. Comparisons were made between patients with and without dermatology consults. MAIN MEASURES: Dermatology DRG admission and consult rates. For consults, frequency of dermatologic procedures performed, treatment recommendations made, changes in diagnoses, and readmissions. KEY RESULTS: Dermatology was consulted in 51 % of cases for dermatology-specific DRGs and in 3 % of cases for dermatology-related DRGs. Dermatology was consulted mainly for common dermatoses such as drug eruptions and cellulitis; among all cellulitis patients, 5 % received a dermatology consult. The most frequent interventions performed were skin biopsies, topical steroid recommendations, and nursing education on skin care. Dermatology consults changed the diagnosis in 45 % of cases. CONCLUSIONS: Dermatologists were often not consulted for the care of patients with dermatology-related DRGs. When dermatologists were consulted, we found an impact on both diagnosis and management.
Asunto(s)
Dermatología/normas , Grupos Diagnósticos Relacionados/normas , Admisión del Paciente/normas , Derivación y Consulta/normas , Enfermedades de la Piel/diagnóstico , Especialización/normas , Adolescente , Adulto , Anciano , Dermatología/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Enfermedades de la Piel/epidemiología , Enfermedades de la Piel/terapia , Adulto JovenRESUMEN
Some hospitals have faced a surge of patients with COVID-19, while others have not. We assessed whether COVID-19 burden (number of patients with COVID-19 admitted during April 2020 divided by hospital certified bed count) was associated with mortality in a large sample of US hospitals. Our study population included 14,226 patients with COVID-19 (median age 66 years, 45.2% women) at 117 hospitals, of whom 20.9% had died at 5 weeks of follow-up. At the hospital level, the observed mortality ranged from 0% to 44.4%. After adjustment for age, sex, and comorbidities, the adjusted odds ratio for in-hospital death in the highest quintile of burden was 1.46 (95% CI, 1.07-2.00) compared to all other quintiles. Still, there was large variability in outcomes, even among hospitals with a similar level of COVID-19 burden and after adjusting for age, sex, and comorbidities.