Painless ulceration due to digital hypoperfusion ischaemic syndrome: case report and literature review.

Digital hypoperfusion ischaemic syndrome (DHIS), also known as steal syndrome, is a well recognised serious complication of haemodialysis (HD) access creation. The clinical presentation varies from cyanosis to tissue loss due to necrosis or gangrene. In this article, we present a case of painless digital ulceration due to DHIS and provide a review of the literature. A 40-year-old-female presented with multiple painless digital ulcerations of the left hand. Her medical profile included atherosclerotic disease, hypertension, hyperparathyroidism and type I diabetes causing retinopathy, peripheral neuropathy, gastroparesis and end-stage renal disease (ESRD). Her ESRD required HD with the construction of a left-arm basilic vein transposition arteriovenous fistula (AVF). A year later, she developed intermittent, painless ulcerations of the left hand. A Doppler ultrasound confirmed the diagnosis of DHIS. The patient was treated with AVF ligation surgery. At six months postoperatively, she had near complete re-epithelialisation of her ulcers. This case is unique in that the patient did not have preceding pain, likely due to her underlying diabetic neuropathy. While DHIS in haemodialysis patients with AVF is well documented in literature, digital ulceration in this context is an advanced form of this condition. Early recognition of digital ulceration as a complication of DHIS may enable early intervention and prevent permanent damage.

Acne Scars: An Update on Management

Acne vulgaris is a troubling skin disease known to have both physiologic and psychological effects on patients. Acne scars, a frequent complication, can further impact patients' quality of life. Scars result from an impairment in the healing process. Acne scars can be categorized as follows: atrophic scars (including ice pick, rolling, boxcar subtypes) and trophic (including hypertrophic and keloid scars), the latter being less common. Though various treatment approaches have been suggested, there is a lack of high-quality evidence on effective, type-specific acne scar approaches. Herein, we aim to review the current evidence for treating various acne scars.

Medical Student and Resident Dermatology Education in Canada During the COVID-19 Pandemic [Formula: see text].

The coronavirus disease 2019 (COVID-19) pandemic and subsequent physical distancing recommendations created major gaps in traditional dermatologic undergraduate and postgraduate medical education delivery. Nevertheless, the educational consequences of various public health restrictions have indirectly set aside the inertia, resistance, and risk averse approach to pedagogical change in medicine. In Canada, rapid collaboration and innovation in dermatologic education has led to novel programs including the implementation of a range of internet-facilitated group learning activities and a dramatic expansion of digital telehealth and virtual care. Going forward, three key issues arising from these developments will need to be addressed: the ongoing assessment of these innovations for efficacy; sustaining the momentum and creativity that has been achieved; and, determining which of these activities are worth maintaining when traditional "tried and true" learning activities can be resumed.

Journey of candidates who were unmatched in the Canadian Residency Matching Service (CaRMS): A phenomenological study.

BACKGROUND: Each year, a number of medical students are unmatched in the Canadian Residency Matching Service (CaRMs) match. Blog posts from previous unmatched students suggest that being unmatched is associated with significant stress. However, no studies have explored the collective experiences of candidates who are unmatched. This study seeks to explore the experiences of Canadian students who were unmatched in the first iteration of their CaRMS applications. METHODS: This was an interview-based qualitative study using a phenomenology approach to explore the perspectives of 15 Canadian participants from seven universities who had previously experienced being unmatched between 2011 and 2017 in CaRMS. Telephone interviews were conducted using a semi-structured guide focusing on the experiences in the following domains: the overall unmatched experience; perceived reasons leading to their unmatched status; resources employed; barriers experienced; recommendations; and, their eventual career outcomes. Field notes were analyzed independently by all authors using thematic analysis and authors independently identified major themes. To reconcile divergent impressions and better situate qualitative impressions of our participants, we used publicly available quantitative data from CaRMS to calculate relevant odds ratios. RESULTS: Our participants universally reported negative emotions, concerns regarding privacy and confidentiality breaches, and stigma faced. Systemic challenges faced by our participants included: lack of information, pressures perceived from undergraduate medical education to apply in the second iteration to specialties that they did not want, and logistical issues such as financial challenges, licensing and scheduling issues. The utility of peer support differed for individual participants, but all those who had support from other unmatched candidates felt that to be useful. CONCLUSIONS: Our participants reported significant challenges faced after being unmatched. Based on these experiences, we identified key areas of support needed for candidates through their unmatched journey.

CONTEXTE: Chaque année, un certain nombre d'étudiants en médecine ne sont pas jumelés par le Service canadien de jumelage des résidents (CaRMs). Selon les billets de blogue publiés par d'anciens étudiants non jumelés, le fait de ne pas être jumelé occasionne un stress considérable. Cependant, aucune étude n'a exploré l'expérience globale des candidats non jumelés. La présente étude a pour but d'examiner les expériences des étudiants canadiens qui n'ont pas été jumelés lors du premier tour du jumelage de leur demande au CaRMS. MÉTHODES: Pour mener cette étude qualitative basée sur des entrevues, nous nous sommes servis d'une approche phénoménologique afin d'explorer les perspectives de quinze (15) participants canadiens de sept universités différentes qui n'ont pas été jumelés par le CaRMS entre 2011 et 2017. Lesentrevues téléphoniques ont été réalisées suivant un guide semi-structuré ciblant les expériences dans les domaines suivants : l'expérience globale de non-jumelage; les raisons perçues menant au non-jumelage; les ressources utilisées; les obstacles rencontrés; les recommandations et les résultats éventuels sur leur carrière. Les feuilles de route ont été analysées de manière indépendante par tous les auteurs en utilisant l'analyse thématique et les auteurs on indépendamment identifié trois thèmes majeurs. Afin de concorder les impressions divergentes et de mieux situer les impressions qualitatives de nos participants, nous avons utilisé les données quantitatives du CaRMS mises à la disposition du public pour calculer les rapports des cotes pertinents. RÉSULTATS: Nos participants ont tous rapporté des émotions négatives, des inquiétudes en ce qui concerne la violation de leur vie privée et de la confidentialité ainsi que de la stigmatisation. Parmi les défis liés au systèmeauxquels nos participants ont fait face,'on compte : le manque d'information, la pression perçue lors des études pré-graduées en médecine de faire une demande de spécialité non désirée lors du second tour du jumelage et les problèmes de logistique comme les difficultés financières, l'obtention d'un permis et les conflits d'horaire. Le degré d'utilité du soutien par les pairs a été différent pour chaque participant, mais tous ceux qui ont reçu de l'appui d'autres candidats non jumelés ont estimé qu'il avait été utile. CONCLUSIONS: Nos participants ont signalé qu'ils ont dû faire face à d'importantes difficultés après avoir été non jumelés. En nous basant sur ces expériences, nous avons identifié les principaux types de soutien qui devraient être fournis tout au long du parcours des candidats non jumelés.

Approach to Chilblains During the COVID-19 Pandemic [Formula: see text].

Coronavirus disease (COVID-19) chilblains is a well-reported cutaneous pattern of severe acute respiratory syndrome coronavirus (SARS-CoV-2). Through this narrative review, we provide an evidence-based overview of idiopathic and secondary chilblains, distinguishing features of COVID-19 chilblains, and a systematic clinical approach to history, examination, investigations, and treatment. In the absence of cold or damp exposure, COVID-19 should be considered as a cause of acute chilblains. The timing of onset of COVID-19 chilblains relative to active SARS-CoV-2 viremia remains unclear. Patients with suspected COVID-19 chilblains should thus follow public health guidelines for COVID-19 testing and self-isolation.

Acquired smooth muscle hamartoma: A case report on the lower extremity with hidrosis.

Smooth muscle hamartomas are benign dermal proliferations of smooth muscle cells. Smooth muscle hamartomas are sub-divided into congenital or acquired; the latter is a rare entity with less than 20 cases being reported in the English literature. Most often asymptomatic, acquired smooth muscle hamartomas follow an indolent course. Treatment in the form of surgical excision can be utilized for symptomatic or cosmetic purposes. Here, we report the first case of an acquired smooth muscle hamartomas of the shin which also uniquely presented with hidrosis. This case highlights the varied clinical spectrum of acquired smooth muscle hamartomas.

Giant Juvenile Xanthogranuloma: Case Report, Literature Review, and Algorithm for Classification.

Juvenile xanthogranuloma (JXG) is a member of the non-Langerhans cell group of proliferative disorders of mononuclear phagocytes. JXG is a benign tumour of histiocytic cells. Classic JXG is divided into 2 main clinical subtypes: dome-shaped papules (<0.5 cm) and single/multiple nodules (<2.0 cm). A rare variant is referred to as giant; this term encompasses JXG lesions larger than 2.0 cm. In this article, we report a case of a congenital cutaneous giant JXG. In addition, we reviewed and analyzed all cases (n = 51) of giant JXG reported in the English literature. We propose an algorithm for classifying giant JXG based on the following factors: onset of lesions (congenital and acquired), number of lesions (solitary ± satellites and multiple), morphology of cutaneous/mucosal lesions (plaque, nodular, ulcerated-nodular, macular, and other), and extracutaneous manifestations.