The Effectiveness of Risankizumab Following Guselkumab Failure in Moderate-to-Severe Psoriasis Patients: A Retrospective Study.

BACKGROUND: Psoriasis is a chronic inflammatory skin disease with a strong genetic predisposition and autoimmune component that is often treated with immunomodulators such as biologic therapy. Guselkumab is a biologic treatment option that selectively targets the p19 subunit of interleukin (IL)-23; risankizumab is a more recently developed monoclonal antibody of the same class that targets IL-23p19. There is limited research around effective treatment response with intra class switching within IL-23-targeted therapies for the treatment of moderate-to-severe plaque psoriasis. OBJECTIVES: The purpose is to assess patient response to risankizumab after guselkumab failure for the treatment of plaque psoriasis. METHODS: A retrospective chart review was conducted for 13 patients meeting inclusion criteria. Physical examination findings were converted to a 5-point static physicians' global assessment (sPGA) score. Baseline, 4-month, and 12-month sPGA scores were assigned from visits immediately prior to and during their course of risankizumab treatment. sPGA scores were analyzed to compare changes between baseline and 4 months and 12 months of therapy. RESULTS: Patients treated with risankizumab had lower sPGA scores after both 4 and 12 months compared to their baseline sPGA score. 46% of patients met the primary outcome of an sPGA score of 0 or 1 at 4 months of risankizumab, increasing to 90% of patients at 12 months. CONCLUSIONS: Our findings reflect an improvement in sPGA scores when patients are treated with risankizumab following guselkumab failure. This highlights the benefit of in-class switch to risankizumab when patients with moderate-to-severe plaque psoriasis have failed multiple treatments including guselkumab.

Disseminated blastomycosis with cutaneous involvement in a 57-year-old woman: a case report and review of management.

Blastomycosis is an infectious disease produced by the fungal organisms, Blastomyces dermatiditis and Blastomyces gilchristi. We present a 57-year-old woman with pulmonary blastomycosis and secondary cutaneous involvement. Her diagnosis was facilitated by dermatology consultation after approximately one year of delay. In endemic areas including Canada and the USA, individuals are at risk for blastomycosis when non-motile fungal spores are inhaled, thus producing pulmonary disease. The organism may disseminate over time, affecting a variety of extrapulmonary organ systems including the skin. In endemic regions of blastomycosis, this important cutaneous manifestation of disease should be considered with a high index of suspicion as to avoid delayed resolution and adverse outcomes.

Rapid resolution of erythrodermic atopic dermatitis with upadacitinib: A case report.

Atopic dermatitis is a chronic inflammatory skin disease that may progress to erythroderma in severe cases. Biologic agents such as dupilumab have recently become the mainstay of systemic treatment for moderate-to-severe cases, yet many patients remain refractory to therapy. Here, we present a case of erythrodermic atopic dermatitis, resistant to prednisone and dupilumab, with remarkably rapid achievement of remission following treatment with upadacitinib, an oral selective Janus kinase 1 inhibitor.

Delayed oleoma formation with injection of oil-suspended testosterone: A case report and review of pathogenesis.

This is the case report of a 51-year-old man who was seen in consult with plastic surgery presenting with painful, disfiguring, submuscular nodules in the bilateral deltoids and right gluteal regions. Pre-operative investigations confirmed the presence of multiple heterogeneous, complex non-vascular fluid collections in the subcutaneous and intramuscular layers. The origin of these lesions was unknown until the post-operative follow-up appointment where the patient revealed that he had injected those areas with testosterone suspended in oil 9 years prior. Later, pathology reports confirmed the presence of numerous granulomas containing yellow viscous fluid and focal areas of calcification consistent with the diagnosis of oleomas. This case presents an important differential in the diagnosis of subcutaneous nodules and a review of pathophysiology of granuloma formation, and highlights some of the complications of oil injection use by bodybuilders.

Health Care Students' Perspectives on Artificial Intelligence: Countrywide Survey in Canada.

BACKGROUND: Artificial intelligence (AI) is no longer a futuristic concept; it is increasingly being integrated into health care. As studies on attitudes toward AI have primarily focused on physicians, there is a need to assess the perspectives of students across health care disciplines to inform future curriculum development. OBJECTIVE: This study aims to explore and identify gaps in the knowledge that Canadian health care students have regarding AI, capture how health care students in different fields differ in their knowledge and perspectives on AI, and present student-identified ways that AI literacy may be incorporated into the health care curriculum. METHODS: The survey was developed from a narrative literature review of topics in attitudinal surveys on AI. The final survey comprised 15 items, including multiple-choice questions, pick-group-rank questions, 11-point Likert scale items, slider scale questions, and narrative questions. We used snowball and convenience sampling methods by distributing an email with a description and a link to the web-based survey to representatives from 18 Canadian schools. RESULTS: A total of 2167 students across 10 different health professions from 18 universities across Canada responded to the survey. Overall, 78.77% (1707/2167) predicted that AI technology would affect their careers within the coming decade and 74.5% (1595/2167) reported a positive outlook toward the emerging role of AI in their respective fields. Attitudes toward AI varied by discipline. Students, even those opposed to AI, identified the need to incorporate a basic understanding of AI into their curricula. CONCLUSIONS: We performed a nationwide survey of health care students across 10 different health professions in Canada. The findings would inform student-identified topics within AI and their preferred delivery formats, which would advance education across different health care professions.