Increased epigenetic age acceleration in the hidradenitis suppurativa skin.

Epigenetic (or DNA methylation) age is calculated based on methylation of certain cytosine-guanine (CpG) repeats, and it can accurately estimate one's chronologic age. Importantly, epigenetic age acceleration (EAA) is highly predictive of age-associated morbidity and all-cause mortality. Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease with significant systemic disease burden. Here, we performed a pilot study to calculate EAA from formalin-fixed paraffin-embedded skin samples using Illumina Infinium MethylationEpic BeadChip arrays. Our results demonstrated no significant difference in intrinsic EAA among HS compared to controls (- 1.00 years, p-value = 0.52), significant increases in both extrinsic EAA (13.72 years, p-value < 0.001) and PhenoAge acceleration (7.72 years, p-value = 0.003), and a significant decrease in GrimAge acceleration (- 5.14 years, p-value < 0.001). Our findings suggest that the acceleration of epigenetic age in the HS skin may be associated with extrinsic immune-related changes and can potentially serve as a biomarker of the present and/or future disease burden in HS patients.

Urgent referrals from primary care to dermatology for lesions suspicious for skin cancer: patterns, outcomes, and need for systems improvement.

Ideally, urgent dermatology referrals for evaluation of a lesion concerning for skin cancer should be triaged and processed with appropriate urgency by primary care and dermatology, respectively. We performed a retrospective single-institution study by conducting chart reviews of all dermatology referrals designated by primary care as urgent for evaluation of a lesion concerning for skin cancer. We identified 320 referrals placed between January 1 and December 31, 2018. Dermatology encounters for these patients occurred on or before 30 days for 50.6% of referrals and on or after 31 days for 38.4% of referrals, with 10.9% never completed. The percentage of all races excluding whites, non-Hispanic in the delayed appointment group (≥ 31 days) was 15.1% higher (95% CI 5.3-24.9) than in the timely appointment group (≤ 30 days). Similarly, the percentage of non-English languages in the delayed group was 7.1% higher (95% CI 0.5-13.7) than in the timely group. Overall, 15.8% of these referrals yielded diagnoses of malignancy, while 76.8% and 7.4% resulted in benign and pre-malignant diagnoses, respectively. The primary care team documented referral status (i.e., completed, incomplete, or pending) during their subsequent visits with the patients in only 37.5% of these referrals. Our findings demonstrate the need to improve the reliability of urgent referrals to ensure they occur in a timely manner with confirmation of "referral loop" closure at the referring clinician's end.

A Brief Report: Comparative Evaluation of Online Spanish and English Content on Pancreatic Cancer Treatment.

The Internet is a major source of patient information on medical subjects. Several studies have evaluated the content of English medical material for patient use. However, few have focused on evaluating other languages, an important gap in a growing Spanish-speaking population. The aim of this study is to evaluate and compare English and Spanish online content related to pancreatic cancer treatment. We conducted a Google web search in English and Spanish using the following terms "pancreatic cancer treatment" and "tratamiento cancer de pancreas." The first 15 educational patient-directed websites for each language were included. Two independent reviewers assessed materials for quality and understandability using the DISCERN and the Patient Education Materials Assessment Tool (PEMAT)-validated tools. Readability was measured using two standardized tests. Wilcoxon rank sum test and unpaired Student's T-test were used for comparisons. Overall, websites in Spanish and English were understandable and had moderate to high quality. There were no significant differences in quality (p = 0.712) and understandability (p = 0.069) between languages. Readability level was significantly higher in English (p < 0.001) with content being at the university level, while Spanish was at the 12th grade level. Patient-directed online content on pancreatic cancer treatments exceeds the recommended reading level in both languages. Material is understandable with reasonable quality. Health content creators should acknowledge readability for information to be easily comprehended by those with lower health literacy.

Overview of use, efficacy, and safety of dupilumab in complex patients: a retrospective, case-series study from a large, urban academic center.

Dupilumab has emerged as an effective treatment option for those suffering from moderate-to-severe atopic dermatitis (AD). Since its approval in 2017 by the United States Food and Drug Administration, dupilumab demonstrated efficacy in a wide range of "off-label" dermatologic conditions. With its increasing use, dermatologists must navigate prescribing dupilumab in complex patient populations. To that end, we performed a single-institution, retrospective, case-series study to assess efficacy, tolerability, and safety of dupilumab in elderly, patients on concomitant immunosuppressive/immunomodulating therapies, and those with pre-existing co-morbidities (e.g., malignancies, chronic renal and/or liver diseases, organ transplantation, hematologic malignancies, and infection). We conducted chart reviews of 248 patients who were prescribed dupilumab between January 1, 2017 and August 31, 2021, and identified 64 patients who met the criteria of being in the complex patient group as described above. Our results showed that 87.5% (56/64) of complex patients demonstrated improvement and/or disease clearance on dupilumab. 20.3% (13/64) of them experienced one or more side effects reported as conjunctivitis, seborrheic dermatitis, psoriasiform eruption, xerosis, facial burning sensation, anaphylactic reaction/angioedema, and worsening of AD. 9.4% (6/64) of them discontinued dupilumab due to the side effects. These findings demonstrated that dupilumab can be safely considered in certain complex patient populations such as elderly and those with significant pre-existing co-morbidities and can be safely combined with immunosuppressive medications and/or other biologic therapies. In the future, more studies with long-term follow-up are needed to validate the efficacy and safety of dupilumab in these challenging patients with complex medical histories.

Slugging: TikTokTM as a source of a viral "harmless" beauty trend.

"Slugging" is a viral beauty trend on TikTokTM that entails slathering a petrolatum-based ointment on the skin as a last step in your evening skincare routine. Due to its occlusive nature, slugging has a potential risk for harm. Here, we screened top 50 TikTok videos on slugging and analyzed upload source, content, and quality of each video. Overall, 18 (36.7%) videos were deemed educational, discussing risks and/or benefits. By upload source, health care providers (HCPs) created more educational videos (87.5%, P = .009), while online influencers created more patient experience videos (43.3%). This difference was evident when comparing the upload source. DISCERN scores (a validated measure of video's quality as a source of information) differed significantly among HCP, influencers, and others (3, 2, 2, respectively, P = .01). Together, our study demonstrates that compared to influencers and others, HCPs created videos of more high-quality, educational content on slugging.

Cutaneous Manifestations of Inflammatory Bowel Disease: A Basic Overview.

Inflammatory bowel disease (IBD) is a chronic inflammatory condition of the gastrointestinal (GI) tract that is subdivided into Crohn's disease (CD) and ulcerative colitis (UC). CD is characterized by involvement of the entire GI tract, while UC mainly affects the distal GI tract. Moreover, both CD and UC can present with extraintestinal manifestations (EIMs) of the disease affecting multiple organ systems including the hepatobiliary tract, kidney, bones, eyes, joints, and skin. These complications can cause significant morbidity and negatively impact the quality of life for IBD patients. Although the pathogenesis of EIMs is not clearly elucidated, it is postulated that the diseased GI mucosa similarly stimulates excess immune responses at the extraintestinal sites. Cutaneous EIMs occur in up to 15% of patients with IBD, often predating their IBD diagnosis. They are categorized into (1) specific, (2) reactive, (3) associated, and (4) treatment-induced. Here, we review the epidemiological, clinical, diagnostic, and histologic features of the most commonly described cutaneous EIMs of IBD along with their respective treatment options.

Systemic comorbidities of rosacea: practice gaps among dermatologists.

Rosacea is a chronic inflammatory skin condition that is associated with multiple systemic comorbidities, with the strongest evidence linking rosacea to hypertension, dyslipidemia, inflammatory bowel disease, and anxiety and depression. To assess dermatologists' awareness of and screening practices for rosacea comorbidities, we developed a survey that was distributed to attendings and residents across four academic dermatology departments in Massachusetts. A total of 73 dermatologists with varying experience participated in the study. Findings demonstrated significant knowledge and practice gaps among academic dermatologists in managing systemic comorbidities in rosacea. In addition, dermatologists' awareness of rosacea comorbidities was negatively correlated with number of years out of residency training, highlighting the need to address this knowledge gap through increased continuing medical education. Importantly, we observed a low screening frequency despite a high awareness of the association between rosacea and ocular comorbidities, suggesting that additional financial, institutional, or practice barriers likely contribute to the low screening rate.

Weight Loss-associated Superior Mesenteric Artery Syndrome, an Unusual Condition in a Peruvian Patient: A Case Report.

Superior mesenteric artery syndrome (SMAS) is an uncommon cause of small bowel obstruction. We report a young male patient with abdominal pain, emesis and history of significant weight loss. Computed tomography angiography demonstrated narrowing of the aortomesenteric angle. The patient underwent conservative medical management, focusing on relieving obstruction and nutritional support.

[Knowledge and perception about tuberculosis among public transport workers in Lima, Peru]. / Conocimientos y percepciones sobre tuberculosis pulmonar en trabajadores del transporte público en Lima, Perú.

OBJECTIVES: To describe the level of knowledge and perception of tuberculosis among public transport workers attending Road Safety Education courses in Lima, Peru. METHODS: An observational, cross-sectional, analytic study was conducted between July and August 2014 in public transport workers attending the courses of Road Safety education. In Lima, such courses are mandatory for workers in the public transport area. An anonymous and voluntary survey was applied to obtain the following variables: sociodemographic characteristics, history of tuberculosis, tuberculosis knowledge and attitudes towards the disease. The factors associated to the risk perception of Tuberculosis infection were analysed using Poisson regression. RESULTS: From 309 attendees, 216 surveys were analysed (69.9%). Of these, 88.4% were males, 3.2% had a history of tuberculosis. The most widely known symptom was cough with phlegm (44.4%), the most popular source of information was television (39.8%), and only 9.7% had any training about tuberculosis. A 41.2% of respondents believed that working in the public transport sector was an occupation with a high risk of tuberculosis infection. No significant association between risk perception of tuberculosis and sociodemographic characteristics was found. CONCLUSION: A considerable lack of knowledge about tuberculosis symptoms and a low perception of risk for tuberculosis exists among public transport workers in Lima. Education strategies directed to this population need to be implemented.

OBJETIVO: Describir los conocimientos y percepciones sobre tuberculosis en asistentes a los cursos de educación vial para operarios del transporte público en Lima, Perú. MÉTODOS: Estudio transversal realizado entre junio y agosto del año 2014, en asistentes al Curso de Educación Vial en Lima (Perú), que son obligatorios para laborar como trabajador del transporte público en dicha ciudad. Se aplicó una encuesta anónima y voluntaria para recolectar datos incluyendo características sociodemográficas, antecedente de tuberculosis, conocimientos y actitudes sobre tuberculosis. Se evaluaron los factores asociados a la percepción de riesgo de contagio mediante la regresión de Poisson. RESULTADOS: De un total de 309 asistentes, se analizaron 216 encuestas (69,9%). El 88,4% fue de sexo masculino, 3,2% había tenido antecedente de tuberculosis, el síntoma más reconocido fue la tos con flema (44,4%), la fuente de información más popular fue la televisión (39,8%), en tanto que sólo 9,7% recibió alguna capacitación sobre tuberculosis. El 41,2% percibió que ser conductor o cobrador de bus es de alto riesgo para contraer tuberculosis, lo cual no estuvo significativamente asociado a otras variables del estudio. CONCLUSIÓN: En la población encuestada se observó escaso conocimiento sobre la sintomatología de la tuberculosis, escasa capacitación recibida sobre el tema y baja percepción de riesgo para contraer esta enfermedad. Urge implementar estrategias de educación dirigidas a dicha población.