Racial Disparities in Diagnosis and Treatment of Patients With Dermatomyositis of Different Skin Tones.

BACKGROUND: Delays in the diagnosis and treatment of dermatological conditions in minorities are a well-documented health disparity. We aimed to determine if there was a delay in detection and treatment initiation for dermatomyositis (DM) and amyopathic dermatomyositis (ADM) in patients of different skin tones. METHODS: Patients from Montefiore Medical Center who met the criteria for DM and ADM were included in this cohort study. Records were reviewed for date of first documented rash, creatine kinase levels, muscle weakness complaints, and date of first steroid or disease-modifying antirheumatic drug initiation. The median number of days between rash documentation and therapy initiation was compared for patients of different races, including non-Hispanic White, non-Hispanic Black, Hispanic, and other (Asian and unknown). Data were compared in White versus non-White skin. RESULTS: Sixty-three DM and 9 ADM patients met the inclusion criteria. There was a shorter time to treatment initiation in White versus non-White patients, with a median number of 8 days compared with 21 days, respectively ( p = 0.05). Kaplan-Meier curves showed prolonged time to diagnosis and treatment in all other races when compared with White patients ( p = 0.03). DISCUSSION: It took clinicians longer to diagnose and treat DM and ADM in patients of color. The trends observed emphasize the importance of increasing dermatology education of non-White skin to improve detection and treatment of DM and ADM and minimize health disparities.

Treatment of Posterior Dislocation of the Mandibular Condyle With the Double Mitek Mini Anchor Technique: A Case Report.

Posterior dislocation of the mandibular condyle is a rare disorder caused by trauma to the chin accompanied by damage to the external auditory canal. Treatment of posterior condylar dislocation (PCD) is directed at repositioning the condyle into the glenoid fossa, preventing recurrent dislocations, and maintaining patency of the ear canal. With early intervention, closed reduction with manual manipulation is successful but could be ineffective for chronic protracted PCD. This case report describes an elderly patient with a chronic protracted PCD resulting from a blow to the chin and in which manual reduction was unsuccessful. An open arthroplasty for condylar reduction and application of a "reverse" double Mitek mini anchor technique was required to prevent recurrence of PCD, with a successful outcome.

Paclitaxel-induced myocarditis presenting as new-onset heart failure.

Myocarditis with systolic dysfunction is not typically associated with paclitaxel use. Here, we present a case of paclitaxel-induced myocarditis with systolic dysfunction developing after two cycles of carboplatin/paclitaxel in a woman with uterine papillary serous carcinoma and no cardiac risk factors. Myocarditis was diagnosed by cardiac MRI. The management of paclitaxel-induced myocarditis includes intravenous diuresis and initiation of heart failure with reduced ejection fraction guideline-directed medical therapy. Cessation of paclitaxel is also recommended in these patients.

Cardiac Manifestations of Viral Infections, Including COVID-19: A Review.

Viral infections have been linked to a variety of cardiac pathology, which may include acute myocarditis, dilated cardiomyopathy, heart failure, cardiogenic shock, pericarditis, acute coronary syndromes, and arrhythmias. We performed a systematic review of literature focusing on the cardiovascular effects of various viral infections, as well as providing an update on the current understanding of the pathophysiology of Coronavirus disease-2019 (COVID-19). Cardiac manifestations of viral illnesses are usually self-limiting, have variable clinical presentations, and require sufficient clinical suspicion for diagnosis and optimal management.

Liquid platelet-rich fibrin injections as a treatment adjunct for painful temporomandibular joints: preliminary results.

OBJECTIVE: To evaluate the clinical benefits of liquid platelet-rich fibrin (PRF) in patients with temporomandibular joint (TMJ) pain and dysfunction. METHODS: Forty-eight TMJs in 37 patients with painful internal derangement (ID) (Wilkes' I-V) were included. Patients were injected with 1.5-2cc of PRF within the superior joint space at 2-week intervals. Pain and subjective dysfunction were recorded using a visual analog scale. Statistical analyses were done using the ANOVA test. RESULTS: Thirty-three of 48 TMJs (69%) showed significant reduction in pain at 8 weeks, and at 3, 6, and 12 months (Responders). Fifteen of 48 TMJs (31%) did not improve (Non-responders). The best Responders to liquid PRF injections were ID stages Wilkes' IV (78.5%) and V (100%), compared to Wilkes' I (0%), II (47%), and III (33%). A non-significant, but notable decrease in dysfunction was found. CONCLUSION: Preliminary findings support that liquid PRF exhibits long-term analgesic effects in most patients with painful TMJ ID.