Low referral rate of overweight/obese patients with hidradenitis suppurativa to weight-management services: a missed opportunity?

Hidradenitis suppurativa (HS) is associated with obesity and other cardiovascular risk factors. Referral of overweight/obese patients with HS to weight-management (WM) services is advised as this may help reduce HS disease severity and cardiovascular risk. A retrospective observational study of 50 patients with HS attending a specialist HS clinic was conducted to assess general practitioner referral patterns of overweight/obese patients with HS for WM. Forty-two patients (84%) were classified as overweight or obese. None of 6 overweight patients and none of 18 obese class 1 patients had been referred to WM prior to dermatology referral, while only 2 of 10 (20%) obese class 2 and 3 of 8 (38%) obese class 3 patients had been referred. The overall WM referral rate for overweight/obese patients was only 12% (n = 5/42). The low referral rate suggests that further efforts are required to diagnose overweight/obesity in primary care, improve the provision of WM services and educate medical professionals that HS is a weight-related comorbidity.

Viral infections in atopic dermatitis.

Individuals with atopic dermatitis are susceptible to frequent viral skin infections due to a compromised epidermal barrier function and immune dysregulation. The diagnosis and management of viral infections in atopic dermatitis can be challenging due to various clinical phenotypes and overlapping clinical features. The literature is reviewed for the diagnosis, aetiology, management, differential diagnoses and complications of these viral infections to provide an up-to-date clinical overview for clinicians involved in caring for patients with atopic dermatitis, including patients with skin of colour. The importance of accurate diagnosis and appropriate management in cases of uncertainty is crucial due to the risk of life-threatening complications with some viral infections. The differing presentations of these infections in patients with skin of colour is highlighted as an underrepresented area of research. Future research with greater diversity of patients is needed for patients with atopic dermatitis complicated by viral skin infections.

Lipedematous Scalp Occurring in Two Female Siblings: Further Evidence for a Genetic Role.

Introduction: Lipedematous scalp (LS) is a rare disorder characterized by thickening of the adipose subcutaneous scalp layer without associated hair loss. To date, there have been fewer than 100 reported cases of LS. LS occurring in siblings has not been previously reported. Case Presentation: We present a 58-year-old and 63-year-old pair of black Caribbean female siblings with LS. Scalp thickness on ultrasound of the vertex in each case was 12 mm and 11 mm from skin to periosteum, respectively (normal range: 5-6 mm). Histopathological analysis in the younger sibling demonstrated prominent fat, high in the dermis around hair follicles, with follicular distortion and focal perifollicular fibrosis. Co-morbidities in the younger sibling were obesity (body mass index [BMI] 39.0), paranoid schizophrenia, and bipolar disorder; the older sibling was overweight (BMI 26.0) with co-morbidities of hypercholesterolemia, type 2 diabetes mellitus, hypomania, and migraines; both siblings were taking psychiatric medication. Conclusion: We present an unusual case of LS in a pair of female siblings, adding to the limited existing evidence that there may be a genetic role in the pathogenesis of LS. Furthermore, both siblings in this case had psychiatric co-morbidities and were taking psychiatric medication, which have not been previously identified as associations of LS.

Role of cell-free DNA levels in the diagnosis and prognosis of sepsis and bacteremia: A systematic review and meta-analysis.

BACKGROUND: Sepsis remains a major cause of mortality in intensive care units (ICUs). Prompt diagnosis and effective management are imperative for better outcomes. In this systematic review and meta-analysis, we explore the potential of circulating cell-free DNA (cfDNA), as a promising tool for early sepsis detection and prognosis assessment, aiming to address limitations associated with traditional diagnostic methods. METHODS: Following PRISMA guidelines, we collected relevant literature from thirteen databases. Studies were included if they analyzed quantitative diagnostic or prognostic cfDNA levels in humans in case of sepsis. We collected data on basic study characteristics, baseline patient demographics (e.g. age and sex), and cfDNA levels across different stages of sepsis. Pooled SMD with 95%-CI was calculated, and Comprehensive Meta-Analysis (CMA) software facilitated meta-analysis. Receiver operating characteristic (ROC) curves were generated to assess cfDNA's combined sensitivity and specificity in diagnostics and prognostics. RESULTS: We included a final of 44 studies, of which, only 32 with 2950 participants were included in the meta-analysis. cfDNA levels were higher in septic patients compared to healthy controls (SMD = 3.303; 95%-CI [2.461-4.145], p<0.01). Furthermore, cfDNA levels were higher in non-survivors than survivors (SMD = 1.554; 95%-CI [0.905-2.202], p<0.01). Prognostic studies demonstrated a pooled sensitivity and specificity of 0.78, while diagnostic studies showed a sensitivity of 0.81 and a specificity of 0.87. CONCLUSION: These findings show that cfDNA levels are significantly higher in sepsis patients compared to control groups and non-survivors in comparison to survivors among both adult and pediatric populations.

Deciphering the role of MicroRNAs in diabetic nephropathy: Regulatory mechanisms and molecular insights.

A serious consequence of diabetes mellitus, diabetic nephropathy (DN) which causes gradual damage to the kidneys. Dietary changes, blood pressure control, glucose control, and hyperlipidemia are all important components of DN management. New research, however, points to microRNAs (miRNAs) as having a pivotal role in DN pathogenesis. Miniature non-coding RNA molecules such as miRNAs control gene expression and impact several biological processes. The canonical and non-canonical routes of miRNA biogenesis are discussed in this article. In addition, several important signaling pathways are examined in the study of miRNA regulation in DN. A deeper knowledge of these regulatory mechanisms would allow for a better understanding of the molecular basis of DN and the development of innovative therapeutic strategies. Finally, miRNAs show tremendous potential as DN diagnostic biomarkers and treatment targets, opening up promising avenues for further study and potential clinical use.

Undergraduate dermatology education: The importance of curriculum review.

In this letter, we highlight the considerable diversity in undergraduate dermatology training in the United Kingdom and acknowledge the barriers faced in implementing the revised national undergraduate curriculum provided by the British Association of Dermatologists (BAD). We provide a pragmatic approach of ensuring that our dermatology placement aligns with the BAD national undergraduate curriculum and Medical Licensing Assessment (MLA) content map, in the face of limited clinician time and placement length. We urge other medical schools to adopt our approach of curriculum mapping, particularly in light of the upcoming MLA, and sustainable educational resource development.

The first consultation with a depressed patient: A qualitative study of GPs' approaches to diagnosis.

Background: The first consultation with a depressed patient is important because many patients do not return for subsequent visits. Therefore, the first consultation provides a unique opportunity for diagnosis (if required) and treatment, but there are risks of both under and over-diagnosis. Aim: To understand how general practitioners utilize diagnosis when patients present with a new episode of depression. Method: We approached a random selection of twenty-one general practitioners (GPs) in Auckland, New Zealand and asked them to participate in a semi-structured telephone interview. The interviews explored "the first consultation for a depressed/distressed patient" were undertaken to theme saturation. Interviews were hand-written and later transcribed. Results: We identified three major themes in GPs' approach to diagnosis. The issue of diagnosis was underpinned by a complex understanding of depression and the GP role. GPs did not always make a formal diagnosis, but the experience of a patient's distress/depression was understood by drawing on a range of factors and resources. These included time, screening tools, clinician experience, and patient affect. GPs were careful about how they communicated a diagnosis, both in their documentation and in their conversations with patients. Conclusion: At an initial appointment, the distressed/depressed patient can present to their GP with various symptoms and differing degrees of distress. GPs draw upon a variety of skills and resources to negotiate these complexities. The value of a diagnosis was questioned and issues such as impairment may be more useful concepts for GPs. This is the first study to report the findings of the first visit.

Treatment of depression in the first primary care consultation: A qualitative study.

Introduction: The first primary care consultation for patients with depression can have long-term consequences for patients, but little is known about treatment decisions at this visit. The aim of this study was to explore the treatment of patients presenting in primary care with a new episode of depression and the drivers behind GPs' treatment decisions at the initial consultation. Materials and Methods: A random sample of GPs in Auckland was invited to participate. A qualitative study was undertaken using semi-structured interviews. Interview transcripts were analyzed using a general inductive approach. Results: Twenty-one GPs were interviewed. We identified three themes as drivers of treatment decisions at the first visit: characteristics of GPs, characteristics of patients, and characteristics of treatment options. Drivers for prescribing were severe depression and time constraints. A driver for non-pharmacological treatment was a strong doctor-patient relationship. Limited time, skill, and training were associated with low confidence using talking therapies. Access to counseling was reported as poor. There was a very wide range of approaches taken. GPs described preferring antidepressants less and talking therapies more with Maori patients. Behavioral activation was used least despite its ease of use and it being one of the most effective treatments for depression. Conclusion: Treatment of depression at the first visit varies widely between practitioners. GPs report multiple barriers to the provision of talking therapies. A move to a more standardized approach may lead to more equitable care. This is the first study to report findings about the initial primary care consultation for depression.

Misconceptions surrounding pregnancy-associated breast cancer.

This case report describes a 31-year-old woman who presented with a right painless breast lump. A mammogram and ultrasound scan showed the lump was suspicious of cancer. Core biopsy and immunohistochemistry of the lump confirmed a triple negative, poorly differentiated, invasive ductal carcinoma of the right breast. One week following her diagnosis, the patient found out she was pregnant. The patient was worried about what the implications this diagnosis would have on both her baby and her own cancer treatment.