RESUMO
Neurons use two main schemes to encode information: rate coding (frequency of firing) and temporal coding (timing or pattern of firing). While the importance of rate coding is well established, it remains controversial whether temporal codes alone are sufficient for controlling behavior. Moreover, the molecular mechanisms underlying the generation of specific temporal codes are enigmatic. Here, we show in Drosophila clock neurons that distinct temporal spike patterns, dissociated from changes in firing rate, encode time-dependent arousal and regulate sleep. From a large-scale genetic screen, we identify the molecular pathways mediating the circadian-dependent changes in ionic flux and spike morphology that rhythmically modulate spike timing. Remarkably, the daytime spiking pattern alone is sufficient to drive plasticity in downstream arousal neurons, leading to increased firing of these cells. These findings demonstrate a causal role for temporal coding in behavior and define a form of synaptic plasticity triggered solely by temporal spike patterns.
Assuntos
Plasticidade Neuronal , Sono/fisiologia , Potenciais de Ação , Animais , Relógios Circadianos/fisiologia , Drosophila , Proteínas de Drosophila/antagonistas & inibidores , Proteínas de Drosophila/genética , Proteínas de Drosophila/metabolismo , Modelos Neurológicos , Neurônios/metabolismo , Optogenética , Canais de Potássio/genética , Canais de Potássio/metabolismo , Canais de Potássio Cálcio-Ativados/metabolismo , Interferência de RNA , RNA Interferente Pequeno/metabolismo , Receptores de N-Metil-D-Aspartato/metabolismo , Transdução de Sinais , ATPase Trocadora de Sódio-Potássio/antagonistas & inibidores , ATPase Trocadora de Sódio-Potássio/genética , ATPase Trocadora de Sódio-Potássio/metabolismo , Transmissão SinápticaRESUMO
BACKGROUND: Chronic inflammatory skin diseases (CISD), such as atopic dermatitis and psoriasis, are associated with nocturnal sleep disturbances, which may in turn exacerbate inflammation. OBJECTIVE: To summarize the complex factors that underlie the relationship between CISD and sleep impairment. METHODS: We conducted a focused review of the published literature, including retrospective, prospective, and interventional studies, clinical trials, reviews, and consensus guidelines. RESULTS: The results of our literature review identified a complex interplay among various physiological, psychosocial, and behavioral factors mediating the relationship between sleep loss and CISD alongside targeted management strategies. We highlight treatment strategies that target these pathways, providing a practical framework for clinicians managing sleep loss in patients with CISD. Current guidelines by dermatology societies on the management of sleep disturbances in patients with CISD are limited and largely focus mostly on atopic dermatitis and psoriasis. CONCLUSIONS: We recommend that sleep problems must be regularly assessed and managed in patients with CISD. Updated clinician guidelines are needed to better recognize and address the multifactorial nature of sleep loss in patients with CISD.
Assuntos
Dermatite Atópica , Psoríase , Distúrbios do Início e da Manutenção do Sono , Transtornos do Sono-Vigília , Humanos , Dermatite Atópica/terapia , Dermatite Atópica/tratamento farmacológico , Estudos Retrospectivos , Estudos Prospectivos , Sono , Psoríase/complicações , Psoríase/terapia , Transtornos do Sono-Vigília/etiologia , Transtornos do Sono-Vigília/terapia , Doença CrônicaRESUMO
PURPOSE: Social determinants of health (SDOH) are linked to poor health care outcomes across the different medical specialties. We conducted a scoping review to understand the existing literature and identify further areas of research to address disparities within hand surgery. METHODS: A systematic search of PubMed, Scopus, and Cochrane was conducted. Inclusion criteria were English studies examining health disparities in hand surgery. The following were assessed: the main SDOH, study design/phase/theme, and main disease/injury/procedure. A previously described health disparities research framework was used to determine study phase: detecting (identifying risk factors), understanding (analyzing risk factors), and reducing (assessing interventions). Studies were categorized according to themes outlined at the National Institute of Health and American College of Surgeons: Summit on Surgical Disparities. RESULTS: The initial search yielded 446 articles, with 49 articles included in final analysis. The majority were detecting-type (31/49, 63%) or understanding-type (12/49, 24%) studies, with few reducing-type studies (6/49, 12%). Patient factors (31/49, 63%) and systemic/access factors (16/49, 33%) were the most frequently studied themes, with few investigating clinical care/quality factors (4/49, 8%), clinician factors (3/49, 6%), and postoperative/rehabilitation factors (1/49, 2%). The most commonly studied SDOH include insurance status (13/49, 27%), health literacy (10/49, 20%), and social deprivation (6/49, 12%). Carpal tunnel syndrome (9/49, 18%), upper extremity trauma (9/49, 18%), and amputations (5/49, 10%) were frequently assessed. Most investigations involved retrospective or database designs (29/49, 59%), while few were prospective, cross-sectional, or mixed-methods. CONCLUSIONS: Despite an encouraging upward trend in health disparities research, existing studies are in the early phases of investigation. CLINICAL RELEVANCE: Most of the literature focuses on patient factors and systemic/access factors in regard to insurance status. Further work with prospective, cross-sectional, and mixed-method studies is needed to better understand health disparities in hand surgery, which will inform future interventions.
Assuntos
Mãos , Qualidade da Assistência à Saúde , Humanos , Estudos Transversais , Mãos/cirurgia , Estudos Prospectivos , Estudos RetrospectivosRESUMO
Understanding the utility of virtual visits in pediatric dermatology practice has become increasingly important in the telehealth era. We compared the conditions diagnosed in pediatric dermatology between traditional in-person visits and virtual telehealth visits during the initial 8-month phase of the COVID-19 pandemic at an urban medical institution. When given the option, pediatric dermatology patients and their families were more likely to choose telehealth visits for the diagnosis and/or management of acne, hemangiomas, and contact dermatitis; however, they were more likely to choose in-person visits for atopic dermatitis, viral warts, and alopecia areata. These differences may be attributed to clinical features of pediatric skin conditions, treatment options, and other factors which may influence patient preference for telehealth or in-person care for their condition. J Drugs Dermatol. 2022;21(11):1260-1263. doi:10.36849/JDD.6843.
Assuntos
COVID-19 , Dermatologia , Dermatopatias , Telemedicina , Humanos , Criança , COVID-19/epidemiologia , Pandemias , Dermatopatias/diagnóstico , Dermatopatias/epidemiologia , Dermatopatias/terapiaRESUMO
BACKGROUND/OBJECTIVES: The COVID-19 pandemic necessitated rapid implementation of telemedicine at medical centers across the United States. As telemedicine is expected to persist beyond the pandemic in subspecialties like pediatric dermatology, there is growing concern that socioeconomic factors may contribute to inequitable telemedicine access. This study aims to identify factors associated with disparities in telemedicine use among pediatric dermatology patients during the pandemic. METHODS: In this single-center cross-sectional study, patients less than 18 years old who completed a visit with a pediatric dermatologist via a video telemedicine call or in-person office visit during the specified time periods were included. Univariate and multivariable analyses were performed to compare demographic factors for (1) patients who had a telemedicine visit versus office visit during June 1, 2020, to January 22, 2021, and (2) patients who had either visit type during June 1, 2020, to January 22, 2021, versus June 1, 2019, to January 2020. RESULTS: The independent factors associated with lower odds of telemedicine include identifying as Black/African American, having a non-English preferred language, and having public insurance, whereas the independent factors reducing overall access to pediatric dermatology care during the pandemic include identifying as Hispanic/Latino and having public insurance. CONCLUSIONS: Differential telemedicine use in vulnerable communities may be attributed to disparities in technology access and digital literacy and should be addressed at a structural level. If such disparities are identified and adequately remedied, telemedicine can serve as an important tool for expanding access in the field of pediatric dermatology.
Assuntos
COVID-19 , Dermatologia , Telemedicina , Adolescente , COVID-19/epidemiologia , Criança , Estudos Transversais , Humanos , Pandemias , Estados Unidos/epidemiologiaRESUMO
The COVID-19 pandemic stimulated adoption of teledermatology via video and telephone modalities by outpatient dermatology clinics. However, it was unknown how patient-related factors may have impacted, whether video or phone visits were used, and if visit modality impacted management. Consequently, we conducted a retrospective cross-sectional study of teledermatology visits occurring between March 30, 2020 and May 30, 2020 at an urban tertiary care center. A total of 788 teledermatology visits including 525 video visits and 263 telephone visits, mostly supplemented by patient-uploaded images, were analyzed. Patient age (P<0.001) and visit type (new versus return patient status), (P<0.001) were significant predictors of likelihood of video visit. No significant difference between video and telephone visits was found with regard to frequency of treatment modification (P=0.52), frequency of biopsy referral (P=0.73), biopsy noncompliance rate (P=0.44), or proportion of biopsies showing a new malignant lesion (P=0.92). With age as a significant predictor of visit modality, maintaining both video and phone modalities could prove useful to maximize patient participation. It appears either can be used without concern that choice of modality would impair the ability to change treatment, recognize a lesion requiring biopsy, recognize a new malignant lesion, or negatively affect compliance with biopsy.
Assuntos
COVID-19 , Centros Médicos Acadêmicos , Estudos Transversais , Humanos , Pandemias , Estudos Retrospectivos , TelefoneRESUMO
Erythema ab igne is an uncommon dermatosis characterized by erythematous or hyperpigmented reticular patches that appear after prolonged localized heat exposure. We present three cases of erythema ab igne in pediatric patients who presented in March and April of 2021 and share a history of space heater usage while engaging in remote schooling during the COVID-19 pandemic.
Assuntos
COVID-19 , Pandemias , Criança , Eritema/epidemiologia , Eritema/etiologia , Temperatura Alta , Humanos , SARS-CoV-2RESUMO
BACKGROUND/OBJECTIVES: Confluent and reticulated papillomatosis is a skin condition with unclear etiology and limited understanding of risk factors, comorbidities, and treatment strategies in the pediatric population. This study aims to describe the varied presentations and outcomes of confluent and reticulated papillomatosis and report associated comorbidities in pediatric patients. METHODS: In this retrospective single-institution case-control study, pediatric patients with a diagnosis of confluent and reticulated papillomatosis seen between 2012 and 2020 were matched approximately 1:5 with an acne vulgaris cohort based on diagnosis, setting, and time period when seen. The primary measures were the clinical features, demographics, comorbidities, treatment, and outcomes of patients with confluent and reticulated papillomatosis. Univariate and multivariable analyses were conducted to describe the association of confluent and reticulated papillomatosis with several potential risk factors and comorbidities. RESULTS: Patients with confluent and reticulated papillomatosis typically presented in adolescence with a median age of 14 years and female predominance. In a multivariable analysis, patients with confluent and reticulated papillomatosis were significantly more likely to identify as Black, be overweight or obese, and have concurrent acanthosis nigricans compared to control patients. Most of the confluent and reticulated papillomatosis patients were treated with oral minocycline or doxycycline. Although all patients who received antibiotics responded to treatment, approximately half presented with recurrence, typically within 1-2 years of first treatment. CONCLUSIONS: Confluent and reticulated papillomatosis is a disorder that presents in adolescence and appears to be more frequent in patients who are Black, obese, or overweight, and also have acanthosis nigricans. Clinicians should assess patients with confluent and reticulated papillomatosis for comorbidities, particularly those associated with insulin resistance, which may help reduce long-term disease burden.
Assuntos
Papiloma , Neoplasias Cutâneas , Adolescente , Estudos de Casos e Controles , Criança , Feminino , Humanos , Recidiva Local de Neoplasia , Papiloma/diagnóstico , Papiloma/tratamento farmacológico , Papiloma/epidemiologia , Estudos Retrospectivos , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/epidemiologiaRESUMO
Although several dermatology-focused research grants for medical students exist, studies have yet to evaluate the outcomes of grant recipients, such as entry into dermatology residency and academic careers. We have described the characteristics of recipients of dermatology-focused medical student research grants and outcomes, including entry into dermatology residency and academic careers, and we have focused on seven dermatology-focused national and regional research grants eligible for U.S. medical students. Data were obtained from publicly available online sources for grants from 2004 to 2023. Of the 235 medical student recipients of dermatology research grants between 2004 and 2023, 45.5% attended one of the top 20 medical schools funded by National Institutes of Health research. Of those who completed medical school, 68.3% advanced to a dermatology residency (n=123/180). Among board-certified dermatologists, 44.7% held an academic position (n=34/76); among those who attended a top 20 medical school, 50% held an academic position (n=23/46) compared to 36.7% who did not (n=11/30). Limitations of this study include selection bias and incomplete data availability. Medical student research grants allow students to thoughtfully engage in dermatology research early in medical education. They may facilitate entry into dermatology residency and academic careers and lead to continued research endeavors.
RESUMO
Systemic isotretinoin is a highly effective treatment for severe and refractory acne but carries risk for serious adverse effects such as teratogenicity. The risk mitigation system used in the United States, iPLEDGE, requires all patients on isotretinoin therapy to complete monthly tasks including follow-up visits with their prescriber, and patients with childbearing potential must additionally undergo monthly pregnancy testing. Female patients seeking isotretinoin are disproportionately affected by iPLEDGE-related barriers and have historically been prescribed isotretinoin less than male patients. The onset of the COVID-19 pandemic and updated regulations permitting at-home pregnancy testing and telehealth for monthly follow-up visits presented an opportunity to study the impact of these changes on the isotretinoin gender gap. We performed a single-center analysis to determine whether gender differences in isotretinoin prescription changed at our institution at the beginning of the pandemic. We found that male predominance of isotretinoin prescriptions was greater during the pandemic compared to pre-pandemic (odds ratios: 4.13 vs. 2.86). Furthermore, male patients were more likely to utilize telehealth compared to in-person visits for isotretinoin follow-up relative to female patients (odds ratios: 6.00 vs. 3.62). Despite the newly introduced flexibilities of telehealth and remote pregnancy testing, gender inequity in receiving isotretinoin treatment persists.
Assuntos
Acne Vulgar , COVID-19 , Fármacos Dermatológicos , Gravidez , Humanos , Masculino , Feminino , Estados Unidos/epidemiologia , Isotretinoína/efeitos adversos , Fármacos Dermatológicos/efeitos adversos , Fatores Sexuais , Pandemias , COVID-19/epidemiologia , Acne Vulgar/tratamento farmacológico , Acne Vulgar/epidemiologia , Prescrições , Centros Médicos AcadêmicosRESUMO
The fan-shaped body (FB) neuropil in the Drosophila brain central complex (CX) controls a variety of adult behaviors, including navigation and sleep. How neuronal processes are organized into precise layers and columns in the FB and how alterations in FB neural-circuit wiring affect animal behaviors are unknown. We report here that secreted semaphorin 2b (Sema-2b) acts through its transmembrane receptor Plexin B (PlexB) to locally attract neural processes to specific FB laminae. Aberrant Sema-2b/PlexB signaling leads to select disruptions in neural lamination, and these disruptions result in the formation of ectopic inhibitory connections between subsets of FB neurons. These structural alternations and connectivity defects are associated with changes in fly sleep and arousal, emphasizing the importance of lamination-mediated neural wiring in a central brain region critical for normal sleep behavior.