RESUMEN
BACKGROUND: The reallocation of health care resources to focus on the acute care needs of COVID-19 patients leads to a delay and deferral of outpatient surgical procedures such as Mohs surgery. OBJECTIVE: Planning for the resumption of regular outpatient surgical care and preparing for future surges in COVID-19 cases requires identifying surrogate markers of health care demand. MATERIALS AND METHODS: United States national and state-based Google search data for "Mohs surgery" and other common elective surgical and cosmetic procedures were evaluated. These were compared with national and state-wide COVID-19 case number and death data from the Johns Hopkins University. Pearson correlation coefficients were generated to assess the association between COVID-19 cases and deaths with Google search trends. RESULTS: Search volume for "Mohs surgery" and other elective surgical and cosmetic procedures significantly decreased as the number of new deaths from COVID-19 increased. Statistically significant inverse correlation was noted between "Mohs surgery" search volume and new COVID-19 deaths on a national and state-based level. CONCLUSION: Search metric analysis may be used as part of a big data model to help predict health care demand during the reopening phase of the COVID-19 pandemic.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios/estadística & datos numéricos , Actitud Frente a la Salud , COVID-19/epidemiología , Técnicas Cosméticas/estadística & datos numéricos , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Cirugía de Mohs/estadística & datos numéricos , Humanos , Pandemias , Neumonía Viral/epidemiología , SARS-CoV-2 , Estados Unidos/epidemiologíaRESUMEN
A 50-year-old woman presented with diffuse, intensely pruritic pink-red papules on her trunk and extremities three weeks after starting combination therapy with ribavirin, telaprevir, and interferon. She also had cervical lymphadenopathy, fever, eosinophilia, and transaminitis consistent with a severe drug reaction to telaprevir. She was started on high potency topical steroids under inpatient observation and recovered within two weeks. Severe cutaneous eruptions secondary to telaprevir have resulted in black-box warnings for potentially fatal skin reactions, including Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) and Stevens-Johnson Syndrome (SJS), and Toxic Epidermal Necrolysis (TEN). Because these reactions carry acute mortality rates of 10%, prompt detection and treatment with steroids are important. As such, physicians should be aware of these potentially lethal side effects.
Asunto(s)
Síndrome de Hipersensibilidad a Medicamentos/etiología , Hepatitis C Crónica/tratamiento farmacológico , Oligopéptidos/efectos adversos , Antiinflamatorios/administración & dosificación , Clobetasol/administración & dosificación , Quimioterapia Combinada , Femenino , Humanos , Persona de Mediana Edad , Ribavirina/uso terapéutico , Síndrome de Stevens-Johnson/etiologíaRESUMEN
Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a clinically heterogeneous entity, encompassing a variety of debilitating conditions that have in common inflammation of the skeletal system and skin. To date, there is a paucity of documented efficacious treatment options. We report a 48-year-old man with skeletal and cutaneous signs and symptoms who improved dramatically after treatment with a combination of isotretinoin and pamidronate. This report provides an alternative treatment regimen for SAPHO that addresses the possible underlying pathophysiology of this likely underdiagnosed syndrome.
Asunto(s)
Erupciones Acneiformes/tratamiento farmacológico , Difosfonatos/uso terapéutico , Hiperostosis/tratamiento farmacológico , Isotretinoína/uso terapéutico , Osteítis/tratamiento farmacológico , Psoriasis/tratamiento farmacológico , Enfermedades de la Piel/tratamiento farmacológico , Sinovitis/tratamiento farmacológico , Quimioterapia Combinada , Humanos , Masculino , Persona de Mediana Edad , Pamidronato , SíndromeRESUMEN
Mohs surgery uses en face frozen section analysis (FSA) with complete margin examination for the excision of select basal cell carcinomas (BCC), obtaining excellent cosmetic outcomes and extremely low recurrence rates. However, Mohs with FSA is time-consuming because of the need to iteratively perform cryosectioning on sequential excisions. Fluorescent microscopies can image tissue specimens without requiring physical sectioning, potentially reducing the time to perform Mohs surgery. We demonstrate a protocol for nonlinear microscopy (NLM) imaging of surgical specimens that combines dual agent staining, virtual H&E rendering, and video rate imaging. We also introduce a novel protocol that enables micron-level co-registration of NLM images with FSA histology, and demonstrate that NLM can reproduce similar features similar to FSA in BCC specimens with both negative and positive surgical margins. We show that the fluorescent labels can be extracted with conventional vacuum infiltration processing, enabling subsequent immunohistochemistry on fluorescently labeled tissue. This protocol can also be applied to evaluate the performance of NLM compared with FSA in a wide range of pathologies for intraoperative consultation.
RESUMEN
Rapid histopathological evaluation of fresh, unfixed human tissue using optical sectioning microscopy would have applications to intraoperative surgical margin assessment. Microscopy with ultraviolet surface excitation (MUSE) is a low-cost optical sectioning technique using ultraviolet illumination which limits fluorescence excitation to the specimen surface. In this paper, we characterize MUSE using high incident angle, water immersion illumination to improve sectioning. Propidium iodide is used as a nuclear stain and eosin yellow as a counterstain. Histologic features of specimens using MUSE, nonlinear microscopy (NLM) and conventional hematoxylin and eosin (H&E) histology were evaluated by pathologists to assess potential application in Mohs surgery for skin cancer and lumpectomy for breast cancer. MUSE images of basal cell carcinoma showed high correspondence with frozen section H&E histology, suggesting that MUSE may be applicable to Mohs surgery. However, correspondence in breast tissue between MUSE and paraffin embedded H&E histology was limited due to the thicker optical sectioning in MUSE, suggesting that further development is needed for breast surgical applications. We further demonstrate that the transverse image resolution of MUSE is limited by the optical sectioning thickness and use co-registered NLM to quantify the improvement in MUSE optical sectioning from high incident angle water immersion illumination.
Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/patología , Microscopía Ultravioleta/métodos , Neoplasias Cutáneas/diagnóstico por imagen , Neoplasias Cutáneas/patología , Neoplasias de la Mama/cirugía , Diseño de Equipo , Femenino , Técnicas Histológicas , Humanos , Procesamiento de Imagen Asistido por Computador , Inmunohistoquímica , Microscopía Ultravioleta/instrumentación , Neoplasias Cutáneas/cirugíaRESUMEN
The tumescent technique of local anesthesia is one of the great techniques developed in the last 20 years. It has dramatically changed the way clinicians perform many cutaneous surgical procedures. Those that use the technique are forever grateful for the insight that Dr. Jeffrey Klein used to push the envelope and discover the safe doses of subcutaneous administration of lidocaine.
Asunto(s)
Anestesia Local/métodos , Anestésicos Locales/administración & dosificación , Técnicas Cosméticas , Lidocaína/administración & dosificación , Anestesia Local/efectos adversos , Anestésicos Locales/efectos adversos , Bicarbonatos/administración & dosificación , Epinefrina/administración & dosificación , Humanos , Inyecciones Subcutáneas/métodos , Lidocaína/efectos adversos , Lipectomía/métodos , Rejuvenecimiento , Venas/cirugíaRESUMEN
CLINICAL QUESTION: What are the screening guidelines for hepatitis B virus (HBV) infection for asymptomatic, nonpregnant adolescents and adults in the United States? BOTTOM LINE: Patients with a high risk of infection, such as those with human immunodeficiency virus (HIV), who use injection drugs, or who live in a household where someone is infected with HBV; men who have sex with men; or patients who come from countries with a high prevalence of HBV infection, should be screened.
Asunto(s)
Hepatitis B/diagnóstico , Tamizaje Masivo/métodos , Guías de Práctica Clínica como Asunto , Adolescente , Adulto , Femenino , Hepatitis B/epidemiología , Hepatitis B/etiología , Humanos , Masculino , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Estados Unidos/epidemiologíaRESUMEN
Appropriate methods for monitoring of the safety of medical devices introduced into clinical practice have been elusive to develop and implement. A novel approach is the application of Bayesian updating, which incorporates existing knowledge regarding event rates into the estimation of risk. This framework has been shown in other domains to be data efficient and to address some of the limitations of conventional statistical methods. In this article, the authors propose a methodologic framework for developing initial prior probability distributions in risk-stratified patient groups and a mechanism for incorporating accumulating procedure safety experience. In addition, they use this methodology to retrospectively analyze the clinical outcomes of 309 patients undergoing an infrequent interventional cardiology procedure, rotational atherectomy. These exploratory analyses demonstrate the feasibility of Bayesian updating applied to medical device safety evaluation and indicate that the methodology is capable of generating stable estimates of risk in a variety of patient risk groups.