Granuloma annulare on the palms.

We present the case of a 72-year-old man with a one-week history of a red rash on the palms of both hands. A 4mm punch biopsy revealed interstitial granulomatous inflammation within the dermis and a colloidal iron stain showed increased dermal acid mucin. Immunohistochemical staining for CD68 confirmed the presence of abundant histiocytes within the dermis. The clinical and pathological correlation was consistent with the diagnosis of interstitial granuloma annulare. Exclusive involvement of the palms is a rare presentation and serves as a reminder for practitioners to keep granuloma annulare in their differential diagnosis when observing palmar plaques.

Analysis of 10 Years of Diagnostic Radiology Match Data: Notable Changes and Their Potential Implications.

RATIONALE AND OBJECTIVES: Identification of shifts in match metrics, such as applicant volumes, match rates, and interview patterns, stands to inform and empower both applicants and programs participating in the NRMP residency match. Residency programs rarely publish their internal data. Accordingly, we employed publicly available resources to evaluate changes in such metrics for the diagnostic radiology match from 2008 to 2018. MATERIALS AND METHODS: Reports made available to the public by the NRMP, alongside student discussion on the AuntMinnie.com and StudentDoctor.net forums, were used to determine applicant volumes, interview volumes, program rank-order-list metrics, match rates, and interview invite patterns. Linear regression and correlation analyses were employed to identify statistically significant trends. RESULTS: No statistically significant trends were identified across the selected timeframe for applicant volumes or match rates. Statistically significant upward trends were identified for total interview volumes, average interviews attended per applicant, and the fraction of programs inviting students to interview before October 1st, the MSPE release date (p < 0.05). A very strong and significant positive correlation was identified between average interviews attended per applicant and the average number of ranks needed by programs to fill a position (p < 0.01, R = 0.804). CONCLUSION: Applicants pursuing a diagnostic radiology residency are attending more interviews, and programs are increasingly inviting students to interview based on incomplete applications. However, there has been no corresponding uptrend in match rates. Moreover, increased applicant interview attendance is highly associated with programs falling further down their rank lists. Given the expenses usually associated with the match process and forthcoming changes to USMLE scoring, these trends may be unsustainable.

Unintended insulin delivery using Omnipod DASH during a high-altitude flight.

Insulin pumps are an important tool in the management of type I diabetes mellitus. Omnipod DASH is a tubeless insulin pump that delivers insulin through customisable basal rate and bolus amounts. There is no data available to date on how this insulin pump delivery system is influenced by changes in atmospheric pressure during flight at high altitudes. We report a case of a 55-year-old woman who developed symptomatic hypoglycaemia while using this pump during flight in a non-pressurised cabin. This report demonstrates the risk of insulin pump therapy at high altitudes. Flight emergencies involving rapid depressurisation may lead to catastrophic hypoglycaemia. Caution should be exercised when using insulin pump therapy during flights and manual insulin delivery should be considered.

Evaluating the Public's Interest in Testicle Tanning: Observational Study.

BACKGROUND: A new and potentially dangerous health trend, testicle tanning, received extensive media attention following a popular television program where a health and fitness influencer touted that testicular tanning increases testosterone levels. It has been shown that the public has a particular interest in tanning wellness trends; thus, given the vague nomenclature of the practice, the abundance of misleading information and support for using UV light by other health influencers may lead to an increase in men exposing themselves to UV radiation and developing associated complications. OBJECTIVE: The aim of this paper is to evaluate the public's interest in testicle tanning. METHODS: Relative search interest was collected from Google Trends, and daily tweet volume was collected using Twitter via Sprout Social. The search was filtered to observe internet activity between February 1, 2022, and August 18, 2022. Autoregressive integrated moving average models were applied to forecast the predicted values through April 30 to compare to the actual observed values immediately following the airing of the show. RESULTS: We found that the relative search interest for testicle tanning peaked (100) on April 19, 2022, following a discussion of the topic on a television program. Compared to the forecasted relative search interest of 1.36 (95% CI -3.29 to 6.01), had the topic not been discussed, it showed a 7252% increase in relative search interest. A similar spike was observed in the volume of tweets peaking on April 18 with 42,736. The expected number of tweets from the autoregressive integrated moving average model was 122 (95% CI -154 to 397), representing a 35,053% increase. CONCLUSIONS: Our results show that the promotion of testicle tanning generated significant public interest in an evidence-lacking and potentially dangerous health trend. Dermatologists and other health care professionals should be aware of these new viral health trends to best counsel patients and combat health misinformation.

Cutaneous Plasmacytosis Associated with Ehrlichiosis in an African-American Patient.

Cutaneous plasmacytosis is a rare disease that presents clinically with multiple red-brown papules and plaques with minimal to no epidermal change. Histopathologic findings include a perivascular dermal infiltration of polyclonal plasma cells. The etiology of cutaneous plasmacytosis is unknown, but hypothesized to be due to persistent or repeated antigenic stimulation. Ehrlichia represents a family of obligate intracellular bacteria that have been associated with the development of plasma cell dyscrasias in the veterinary literature. We present a case of a 67-year-old male patient with the development of progressively worsening cutaneous plasmacytosis following prolonged hospitalization secondary to ehrlichiosis sepsis. The patient initially presented with isolated cutaneous involvement and normal laboratory findings that eventually progressed to include multiple laboratory abnormalities, including anemia, hyperproteinemia, and elevated serum creatinine. Further diagnostic workup was declined by the patient despite evidence of progression to systemic plasmacytosis or multiple myeloma.

Light-Dependent Electrical Activity in Sea Urchin Tube Feet Cells.

Sea urchins can detect and respond to light, and many species of sea urchins are negatively phototaxic. Light detection is hypothesized to occur via photoreceptors located on sea urchin tube feet, and opsins have been detected in tube feet, spines, and the test. However, the molecular mechanisms underlying light detection are, for the most part, unknown. Individual tube feet disc cells were isolated from purple sea urchins (Strongylocentrotus purpuratus), and the electrical responses of these cells to varying levels of illumination were quantified using the patch clamp technique. No currents were observed under bright illumination, whereas under dark conditions, large, slowly activating currents were consistently observed. Two types of cells were functionally identified based on their responses to darkness. Type I cells sustained currents indefinitely in the dark, whereas Type II cell currents spontaneously decayed after several seconds. The large currents observed were composed of the summation of many smaller events that were characterized by a rapid onset and an exponentially decaying component, which may be indicative of direct vesicular release from the tube feet disc cells in response to the dark conditions.

Pharmacological Disruption of Sea Urchin Tube Foot Motility and Behavior.

The understanding of the molecular basis of sea urchin behavior and sensory and motor systems lags far behind that of many other animal species. To investigate whole-animal behavior pharmacologically, we first demonstrated that immersion in drug solution is an effective drug administration route for sea urchins, whereas oral drug administration was found to be ineffective. Although intracoelomic injection was found to be effective at administering drugs, it was also found that injection itself can disrupt normal sea urchin behavior. Using the drug immersion procedure, we demonstrate that sea urchin locomotion and the sea urchin righting response are inhibited in a dose-dependent manner by the phosphodiesterase inhibitor theophylline and the transient receptor potential channel inhibitor 2-aminoethoxydiphenyl borate. The sea urchin righting response was also inhibited by the nitric oxide synthase inhibitor N(G)-nitro-l-arginine methyl ester and the Ca2+ channel inhibitor diltiazem, which, along with theophylline and 2-aminoethoxydiphenyl borate, would all be expected to disrupt smooth muscle function, based on studies in other animals. In addition, the removal of extracellular Ca2+ also inhibited the righting response, whereas an inhibitor of intracellular Ca2+ release, thapsigargin, did not affect the righting response, indicating that extracellular Ca2+ rather than intracellular Ca2+ stores are required for righting.