Physician complicity in human rights violations: Involuntary sterilization among women from Mexico and Central America seeking asylum in the United States.

Involuntary sterilization is a violation of human rights and grounds for asylum in the United States. Forensic medical evaluations can be useful in documenting this form of persecution and supporting asylees' claims for immigration relief. We conducted a retrospective case analysis of the personal and medical affidavits of 14 asylum-seeking women from four Latin America countries who all reported they had been involuntarily sterilized. Sixty-four percent said that "consent" was coerced; the remainder were unaware of having been sterilized at the time of the procedure. In all cases, findings on hysterosalpingogram were consistent with sterilization, revealing that all 14 had undergone a tubal ligation. Eighty-six percent of the women had been sterilized at the time of childbirth. The healthcare providers involved in the 14 cases failed to obtain informed consent, misled patients about sterilization, engaged in discriminatory behavior, and/or breached patient confidentiality regarding their HIV-status. All 14 asylum cases were defensive; of the 7 cases (50%) that have been decided to date, 100% have been granted asylum.

A survey-based study of physician practices regarding biotin supplementation.

Biotin is an important cofactor in several metabolic pathways in humans. Biotin deficiencies are quite uncommon and there is limited data to support recommending it to treat hair, skin, and nail conditions. A 2017 FDA safety alert warned that biotin can interfere with laboratory testing resulting in incorrect diagnoses and even death. Therefore, our study objectives were to assess biotin recommendation practices and survey physician knowledge of biotin interference in routine laboratory tests. In a national survey of 149 physicians, we found that 43.9% of physicians prescribe biotin, primarily for hair and nail disorders, and 39.5% recommended other biotin-containing supplements. Most physicians answered correctly that there are no randomized studies that biotin improves dermatological conditions, and that biotin interferes with thyroid and troponin testing. Few knew of interference with b-HCG, Hepatitis serology, HIV serology and Vitamin D levels, and 19.5% were unaware of any interference. Almost half of physicians did not ask patients to discontinue biotin prior to laboratory testing. Our study shows that physicians continue to prescribe biotin despite knowledge gaps about laboratory interference, and highlights the need for increasing physician awareness of risks and benefits of recommending biotin to treat skin, hair, and nail conditions.

Impact of forensic medical evaluations on immigration relief grant rates and correlates of outcomes in the United States.

The purpose of this study was to investigate the impact of forensic medical evaluations on grant rates for applicants seeking immigration relief in the United States (U.S.) and to identify significant correlates of grant success. We conducted a retrospective analysis of 2584 cases initiated by Physicians for Human Rights between 2008 and 2018 that included forensic medical evaluations, and found that 81.6% of applicants for various forms of immigration relief were granted relief, as compared to the national asylum grant rate of 42.4%. Among the study's cohort, the majority (73.7%) of positive outcomes were grants of asylum. A multivariable regression analysis revealed that age, continent of origin, history of sexual or gender-based violence, gang violence, LGB sexual orientation, and being detained by the U.S. government at the time of evaluation request were statistically associated with case outcomes. Forensic physical evaluation was more strongly associated with a positive outcome than forensic psychological evaluation. Our findings strengthen and expand prior evidence that forensic medical evaluations can have a substantial positive impact on an applicant's immigration relief claim. Given the growing applicant pool in the U.S., there is an urgent need for more trained clinicians to conduct forensic medical evaluations as well as to educate adjudicators, immigration lawyers, and policy makers about the traumatic nature of the life-altering events that applicants for immigration relief experience.

Field Research Experience of Medical Students: Learning and Translation from Global to Underserved US Settings.

While most medical schools in the USA provide opportunities for global health experiences, global health education is not included consistently or emphasized adequately in many medical school curricula. The City University of New York Medical School (CSOM) has a mission to educate and train students who are traditionally underrepresented in medicine to practice primary care in medically underserved communities in New York. This manuscript documents the experience of the CSOM in expanding global health education by introducing a new global health cancer training program, partnering with clinicians at the Ocean Road Cancer Institute (ORCI) in Tanzania. This manuscript illustrates the following points: (1) the CSOM curriculum that focuses on community health and social medicine; (2) the process by which students learn by developing research proposals for global cancer; (3) the field research experience and lessons learned; (4) learning about cancer and medicine in a developing country; and (5) lessons learned for translation from global to domestic underserved populations. We also suggest a checklist for future students interested in pursuing global cancer education and research, and recommendations for maximizing learning and career development of students interested in global cancer research and its application to underserved populations in the USA.

Factors related to completion of referral among women with suspected cervical cancer and dysplasia in Tanzania.

OBJECTIVE: To investigate completion of referral among women with suspected cervical cancer in Tanzania. METHODS: Retrospective cohort study of 196 women referred from two healthcare clinics to Ocean Road Cancer Institute, Dar es Salaam, between March 2016 and June 2018. Women with precancerous lesions or suspected cancer were interviewed about their knowledge and perception of cervical cancer and referred for follow-up. RESULTS: Most participants were unable to name symptoms (55.1%), prevention methods (88.3%), or treatments (59.0%), although 79.1% rated the disease as severe. Women who came for routine early detection were less likely to complete referral than those who did not (odds ratio [OR], 0.18; 95% confidence interval [CI], 0.05-0.70). Women who knew someone who died from cervical cancer were 5.40 times more likely to complete referral than those who did not. Knowing someone with cervical cancer was a predictor of referral completion in three multivariate models: OR, 5.62 (95% CI, 2.20-14.38); 4.34 (1.64-11.47); and 4.61 (1.72-12.36). Having severe symptoms was a predictor of non-completion in two models: 0.30 (0.12-0.75) and 0.35 (0.14-0.87). CONCLUSION: Patient-directed interventions should include education involving survivors of cancer and dysplasia, whereas system-directed interventions should utilize reminders to increase referral completion.

Use of clinical chromosomal microarray in Chinese patients with autism spectrum disorder-implications of a copy number variation involving DPP10.

BACKGROUND: Array comparative genomic hybridization (aCGH) is recommended as a first-tier genetic test for children with autism spectrum disorder (ASD). However, interpretation of results can often be challenging partly due to the fact that copy number variants (CNVs) in non-European ASD patients are not well studied. To address this literature gap, we report the CNV findings in a cohort of Chinese children with ASD. METHODS: DNA samples were obtained from 258 Chinese ASD patients recruited from a child assessment center between January 2011 and August 2014. aCGH was performed using NimbleGen-CGX-135k or Agilent-CGX 60k oligonucleotide array. Results were classified based on existing guidelines and literature. RESULTS: Ten pathogenic CNVs and one likely pathogenic CNV were found in nine patients, with an overall diagnostic yield of 3.5%. A 138 kb duplication involving 3' exons of DPP10 (arr[GRCh37] 2q14.1(116534689_116672358)x3), reported to be associated with ASD, was identified in one patient (0.39%). The same CNV was reported as variant of uncertain significance (VUS) in DECIPHER database. Multiple individuals of typical development carrying a similar duplication were identified among our ancestry-matched control with a frequency of 6/653 (0.92%) as well as from literature and genomic databases. CONCLUSIONS: The DPP10 duplication is likely a benign CNV polymorphism enriched in Southern Chinese with a population frequency of ~1%. This highlights the importance of using ancestry-matched controls in interpretation of aCGH findings.

A staging system for gluteal foreign body reaction to injectables.

BACKGROUND: Esthetic augmentation of the gluteal region can lead to complications including debilitating pain, infections, wounds, and scars. To our knowledge, a general consensus of staging and treatment guidelines for managing gluteal foreign body reaction to injectables has not yet been established. OBJECTIVE: The objective of this study was to develop a reliable staging system that can be used to implement a treatment algorithm for gluteal foreign body reactions. METHODS: A retrospective review of 40 patients treated for complications of gluteal injections between September 2010 and May 2014 was performed. Patient symptoms, imaging, and photographs were used to develop a staging system of disease. Institutional review board approval was obtained from the University of Miami Miller School of Medicine. Five independent observers reviewed the patients' documented symptoms and photographs. Using our staging system, the independent observers reviewed the patient cases at two separate time intervals. Intra- and interclass correlation coefficients (ICCs) were computed to assess the reliability for each of the observers. RESULTS: Seven patients were classified as Stage I, fifteen as Stage IIa, nine as Stage IIb, and nine as Stage III. The mean patient age was 34 years (21-50). Analysis of the independent reviewer results revealed ICC for each rater to range from 0.96 to 0.98, demonstrating high indexes of intra-rater reliability. CONCLUSIONS: Based on our statistical analysis, we found an excellent inter- and intra-observer reliability, indicating that the staging system is reproducible and reliable. A treatment strategy dependent on the stage can be implemented as a guideline to optimize functional and esthetic outcomes.

Optimizing Skin Grafting Using Hair-derived Skin Grafts: The Healing Potential of Hair Follicle Pluripotent Stem Cells.

BACKGROUND: A man in his 60s with recurrent venous leg ulcers (VLUs) presented with an 18-month history of a VLU on his medial left leg measuring 59.3 cm(2). He had been treated with multi- component compression bandages without significant decrease in ulcer size. Given the ulcer's size, refractory nature, and history of recurrence, the authors sought to optimize the patient's healing. METHODS: Approximately 23% of the total wound was treated using punch grafts (PGs) harvested from different locations on the body based on hair density using the "stick and place" method. RESULTS: One month later, a 56% reduction in ulcer size was observed, especially in the area that received hair-bearing skin. CONCLUSION: Punch grafts from hair-bearing skin are a viable source of follicular stem cells and may be superior to PG from nonhair-bearing skin for the treatment of chronic wounds.

Effect of physical therapy on wound healing and quality of life in patients with venous leg ulcers: a systematic review.

IMPORTANCE: Patients with venous leg ulcers (VLUs) have calf muscle pump dysfunction, which is associated with reduced ankle range of motion (ROM). Physical therapy or exercise that targets ankle joint mobility may lead to improvement in calf muscle pump function and subsequent healing. However, little is known regarding the effect of physical therapy or exercise on healing and quality of life (QOL), which is impaired in patients with VLUs. OBJECTIVES: To systematically review the current literature on the effect of physical therapy on healing and QOL outcomes in patients with VLUs and to identify research gaps that warrant further investigation. EVIDENCE REVIEW: PubMed (MEDLINE), CINAHL, and Cochrane databases were searched in April 2014. FINDINGS: We found 10 articles, consisting of randomized clinical trials and single-arm cohort studies with small sample sizes, that used physical therapy or exercise for patients with open or healed VLUs. Although there is evidence that exercise strengthens the calf muscle pump and improves ankle ROM, few studies have investigated the effect of these interventions on QOL and healing, and few involved the supervision of a physical therapist. CONCLUSIONS AND RELEVANCE: The lack of evidence and randomized clinical trials suggests the need for further investigation on physical therapy-oriented exercise on wound healing and QOL. In addition, more studies are needed to investigate sustainability of the increased ankle ROM after physical therapy has ended or if VLU reoccurrences are prevented.

5α-Reductase inhibitors in androgenetic alopecia.

PURPOSE OF REVIEW: The authors will review the current literature on efficacy and safety of 5-alpha reductase inhibitors (5αRIs) for androgenetic alopecia (AGA). RECENT FINDINGS: The 5αRI finasteride and dutasteride are effective in treating AGA and promoting hair regrowth. 5αRI can be given orally, topically and more recently through mesotherapy. However, there has been an increasing concern about permanent sexual adverse events such as impotence and infertility. Most of these reports are published as case reports, and two studies reporting persistent sexual side-effects after discontinuation of finasteride had serious method limitations, as patients were recruited from a website. To our knowledge, permanent sexual adverse events have yet to be published in higher quality studies, such as randomized controlled trials. Although patients treated with 5αRIs have an increased incidence of sexual adverse events, these events decrease if discontinued or over time with continued therapy. SUMMARY: Sexual side-effects are uncommon and resolve spontaneously in most patients even without discontinuing therapy. Significant effort is underway to find delivery systems that optimize delivery and reduce systemic absorption of topical 5αRs including hydroxypropyl chitosan and liposomal and nanoparticulate systems.

Contact dermatitis caused by preservatives.

Preservatives are biocidal chemicals added to food, cosmetics, and industrial products to prevent the growth of microorganisms. They are usually nontoxic and inexpensive and have a long shelf life. Unfortunately, they commonly cause contact dermatitis. This article reviews the most important classes of preservatives physicians are most likely to encounter in their daily practice, specifically isothiazolinones, formaldehyde and formaldehyde-releasers, iodopropynyl butylcarbamate, methyldibromoglutaronitrile, and parabens. For each preservative mentioned, the prevalence of sensitization, clinical presentation of contact dermatitis, patch testing concentrations, cross reactions, and related legislation will be discussed. Mandatory labeling of preservatives is required in some countries, but not required in others. Until policies are made, physicians and patients must be proactive in identifying potential sensitizers and removing their use. We hope that this article will serve as a guide for policy makers in creating legislation and future regulations on the use and concentration of certain preservatives in cosmetics and industrial products.

The effect of ankle range of motion on venous ulcer healing rates.

Limitation of ankle movement may contribute to calf muscle pump failure, which is thought to contribute to venous leg ulcer formation, which affects nearly 1 million Americans. We therefore wished to study ankle movement in patients with venous leg ulcers and its effect on healing. Using goniometry, we measured baseline ankle range of motion in venous leg ulcer patients from a Phase 2 dose-finding study of an allogeneic living cell bioformulation. Two hundred twenty-seven patients were enrolled in four active treatment groups and one standard-care control group, all receiving compression therapy. Goniometry data from a control group of 49 patients without venous disease, from a previous study, was used for comparison. We found patients with active venous leg ulcers had significantly reduced ankle range of motion compared with the control group (p = 0.001). After 12 weeks of therapy, baseline ankle range of motion was not associated with healing, as there was no significant difference between healed and nonhealed groups, suggesting that ankle range of motion is not important in venous leg ulcer healing or, more likely, is overcome by compression. However, patients with venous ulcers located on the leg (as opposed to the ankle) had significantly higher ankle range of motion for plantar flexion and inversion (p = 0.021 and p = 0.034, respectively) and improved healing with both cell bioformulation and standard care (p = 0.011), suggesting that wound location is an important variable for ankle range of motion as well as for healing outcomes.