Pagetoid Reticulosis: A Rare Dermatologic Malignancy Presenting in a Middle-Aged Female.

Pagetoid reticulosis is a rare form of cutaneous T cell lymphoma, a malignancy of T lymphocytes, that invades the skin leading to a multitude of dermatologic manifestations. Pagetoid reticulosis commonly presents as a localized slow-growing or indolently manifesting hyperkeratotic patch/plaque on the extremities that is confined to the epidermis. Diagnosis is confirmed via a skin biopsy of the affected area followed by a cytologic examination. Treatment typically entails topical corticosteroids, alkylating agents, and retinoids. With disseminated disease, a multidisciplinary approach involving chemotherapy and radiation is necessary. To raise awareness about pagetoid reticulosis, its diagnosis, and management, we report a case localized to the left forehead and earlobe of a 57-year-old female.

Human Papillomavirus (HPV)-Associated Squamous Cell Carcinoma In situ With Positive p16 and Ki-67 Immunohistochemical Stains in a Young Immunocompetent Patient.

There is an oncogenic role of human papillomavirus (HPV) in the development of premalignant and malignant skin cancers, especially squamous cell carcinomas (SCCs). Some of the major risk factors for SCC include older age, fair skin types, immunosuppression, ultraviolet radiation (UVR), history of epidermodysplasia verruciformis (EV), and co-carcinogenesis by the HPV. Our case report exemplifies a unique case of a low-risk, 34-year-old female who developed an HPV-associated squamous cell carcinoma in situ (SCCIS) on her left palmar hand, despite having none of the contributing risk factors. The biopsy also showed full-thickness keratinocyte atypia and increased mitotic activity throughout all the layers of the epidermis. Immunohistochemical stains showed strong and diffuse nuclear staining of p16 and Ki-67 throughout the SCCIS, confirming HPV etiology. We speculate that tumor development in our patient relied on the combined effects of UVR exposure, localized immunosuppression, and the co-carcinogenic effects of HPV infection.

What Searches Do Users Run on PEDro? An Analysis of 893,971 Search Commands Over a 6-Month Period.

BACKGROUND: Clinicians must be able to search effectively for relevant research if they are to provide evidence-based healthcare. It is therefore relevant to consider how users search databases of evidence in healthcare, including what information users look for and what search strategies they employ. To date such analyses have been restricted to the PubMed database. Although the Physiotherapy Evidence Database (PEDro) is searched millions of times each year, no studies have investigated how users search PEDro. OBJECTIVES: To assess the content and quality of searches conducted on PEDro. METHODS: Searches conducted on the PEDro website over 6 months were downloaded and the 'get' commands and page-views extracted. The following data were tabulated: the 25 most common searches; the number of search terms used; the frequency of use of simple and advanced searches, including the use of each advanced search field; and the frequency of use of various search strategies. RESULTS: Between August 2014 and January 2015, 893,971 search commands were entered on PEDro. Fewer than 18 % of these searches used the advanced search features of PEDro. 'Musculoskeletal' was the most common subdiscipline searched, while 'low back pain' was the most common individual search. Around 20 % of all searches contained errors. CONCLUSIONS: PEDro is a commonly used evidence resource, but searching appears to be sub-optimal in many cases. The effectiveness of searches conducted by users needs to improve, which could be facilitated by methods such as targeted training and amending the search interface.

Performance tests in people with chronic low back pain: responsiveness and minimal clinically important change.

STUDY DESIGN: Cohort study. OBJECTIVE: To assess the responsiveness and minimal clinically important change (MCIC) of 6 commonly-used performance tests (5-minute walking, 50-ft walking, sit-to-stand, 1 minute stair climbing, loaded forward reach, Progressive Isoinertial Lifting Evaluation). SUMMARY OF BACKGROUND DATA: Performance tests are used to evaluate physical function in people with low back pain. Little is known about their clinimetric properties. METHODS: Performance tests were administered in people with chronic nonspecific low back pain (n = 198) before and after 10 weeks of treatment. At 10 weeks, the global perceived effect scale was used to determine if participants judged themselves as worsened, unchanged, or improved. The mean change scores for each performance test were calculated. A performance test was considered responsive if the area under the receiver operating characteristic curve (AUC) was equal to or greater than 0.70. We used 2 methods to evaluate MCIC: the optimal cut-off point based on the receiver operating characteristic curve, which takes into account both sensitivity and specificity, and the minimal detectable change for improvement, which considers test specificity only. RESULTS: In general, the mean change scores were the smallest in participants who judged themselves worsened and largest in those reporting to be improved. Sit-to-stand (AUC = 0.75) and stair climbing (AUC = 0.72) were the only performance tests that showed adequate responsiveness. For sit-to-stand, the MCIC ranged from 4.1 to 9.8 seconds (19%-45% of the mean baseline score). For stair climbing, the MCIC ranged from 14.5 to 23.9 steps (19%-31% of the mean baseline score). CONCLUSION: Only 2 of the 6 performance tests were responsive. Both had acceptable MCIC values. Developing individualized performance tests might partly overcome the general lack of responsiveness of performance tests. Future research should focus on the clinimetric testing of performance tests in subgroups.