Defining D-irAEs: consensus-based disease definitions for the diagnosis of dermatologic adverse events from immune checkpoint inhibitor therapy.

With an increasing number of patients eligible for immune checkpoint inhibitors, the incidence of immune-related adverse events (irAEs) is on the rise. Dermatologic immune-related adverse events (D-irAEs) are the most common and earliest to manifest, often with important downstream consequences for the patient. Current guidelines lack clarity in terms of diagnostic criteria for D-irAEs. The goal of this project is to better define D-irAE for the purposes of identification, diagnosis, and future study of this important group of diseases.The objectives of this project were to develop consensus guidance for an approach to D-irAEs including disease definitions and severity grading. Knowing that consensus among oncologists, dermatologists, and irAE subspecialists would be critical for usability, we formed a Dermatologic irAE Disease Definition Panel. The panel was composed of 34 experts, including oncologists, dermatologists, a rheumatologist, and an allergist/immunologist from 22 institutions across the USA and internationally. A modified Delphi consensus process was used, with two rounds of anonymous ratings by panelists and two virtual meetings to discuss areas of controversy. Panelists rated content for usability, appropriateness, and accuracy on 9-point scales in electronic surveys and provided free text comments. A working group aggregated survey responses and incorporated them into revised definitions. Consensus was based on numeric ratings using the RAND/UCLA Appropriateness Method with prespecified definitions.Following revisions based on panelist feedback, all items received consensus in the second round of ratings. Consensus definitions were achieved for 10 core D-irAE diagnoses: ICI-vitiligo, ICI-lichen planus, ICI-psoriasis, ICI-exanthem, ICI-bullous pemphigoid, ICI-Grover's, ICI-eczematous, ICI-eruptive atypical squamous proliferation, ICI-pruritus without rash, and ICI-erosive mucocutaneous. A standard evaluation for D-irAE was also found to reach consensus, with disease-specific exceptions detailed when necessary. Each disorder's description includes further details on disease subtypes, symptoms, supportive exam findings, and three levels of diagnostic certainty (definite, probable, and possible).These consensus-driven disease definitions standardize D-irAE classification in a useable framework for multiple disciplines and will be the foundation for future work. Given consensus on their accuracy and usability from a representative panel group, we anticipate that they can be used broadly across clinical and research settings.

Rosehip extract and wound healing: A review.

BACKGROUND: Each year, over 100 million patients are afflicted with new scars from medical procedures worldwide. Natural compounds have shown promise in the treatment of scars and skin disorders. Rosehip oil (RO), produced from the pressed fruit of the rosehip (Rosa canina L.) plant, is used in the pharmaceutical, cosmetic, and food industries. The use of this plant in the treatment of scars has yet to be reviewed. AIMS: This review aims to analyze the current findings on the use of RO in the treatment of postsurgical scars. METHODS: This literature search considered published journal articles (clinical trials or literature reviews). Studies were identified by searching electronic databases (PubMed and MEDLINE) and reference lists of respective articles. Additional articles were identified through Google Scholar. Only articles available in English were included in this review. RESULTS: There is a scarcity of high-quality studies assessing the therapeutic potential of RO. From the two human clinical trials using RO, there is some evidence to suggest its potential as an active ingredient in topical formulations for the treatment of wounds. Topical treatments containing RO extract may reduce the size and erythema of postsurgical scars through the polarization of macrophages and the inhibition of inflammatory cytokines. CONCLUSIONS: Some evidence suggests that RO may improve postsurgical scars. At present, there is insufficient evidence to recommend the use of RO for the treatment of wounds. Further investigation is required to establish its therapeutic effects on human skin and its potential use as an ingredient in topical formulations.

Virtual Team Rounding: A Cross-Specialty Inpatient Care Staffing Program to Manage COVID-19 Surges.

PROBLEM: The SARS-CoV-2 (COVID-19) pandemic presented numerous challenges to inpatient care, including overtaxed inpatient medicine services, surges in patient censuses, disrupted patient care and educational activities for trainees, underused providers in certain specialties, and personal protective equipment shortages and new requirements for physical distancing. In March 2020, as the COVID-19 surge began, an interdisciplinary group of administrators, providers, and trainees at Brigham and Women's Hospital created an inpatient virtual staffing model called the Virtual Team Rounding Program (VTRP). APPROACH: The conceptual framework guiding VTRP development was rapid-cycle innovation. The VTRP was designed iteratively using feedback from residents, physician assistants, attendings, and administrators from March to June 2020. The VTRP trained and deployed a diverse set of providers across specialties as "virtual rounders" to support inpatient teams by joining and participating in rounds via videoconference and completing documentation tasks during and after rounds. The program was rapidly scaled up from March to June 2020. OUTCOMES: In a survey of inpatient providers at the end of the pilot phase, 10/10 (100%) respondents reported they were getting either "a lot" or "a little" benefit from the VTRP and did not find the addition of the virtual rounder burdensome. During the scaling phase, the program grew to support 24 teams. In a survey at the end of the contraction phase, 117/187 (62.6%) inpatient providers who worked with a virtual rounder felt the rounder saved them time. VTRP leadership collaboratively and iteratively developed best practices for challenges encountered during implementation. NEXT STEPS: Virtual rounding provides a valuable extension of inpatient teams to manage COVID-19 surges. Future work will quantitatively and qualitatively assess the impact of the VTRP on inpatient provider satisfaction and well-being, virtual rounders' experiences, and patient care outcomes.

REGAT: A permanent GPS network in Algeria, configuration and first results.

The REGAT ("REseau Géodésique de l'ATlas") geodetic network is composed of 53 continuously-recording GPS stations distributed in the Algerian Atlas. It spans the whole width of the Algerian coast and reaches 300 km inland, with inter-sites distance of about 100 km. One additional site is located in Tamanrasset in the southernmost part of the country. The network, whose oldest stations started operating in 2007, encompasses the main active tectonic features of the most seismically active segment of the Nubia-Eurasia plate boundary in the Western Mediterranean. Here we describe the network configuration, the data collection and analysis strategy, as well as some preliminary results on horizontal GPS velocities. A detailed analysis of the velocity field in terms of plate boundary kinematics is the topic of a separate publication. The REGAT network fills an important gap in our knowledge of present-day plate boundary deformation in the Western Mediterranean. It will soon be enhanced by an additional 100 sites in order to improve deformation monitoring with a higher spatial resolution for a better assessment of the regional seismic hazard.

Kerion of the vulva caused by Trichophyton mentagrophytes.

BACKGROUND: Deep dermatophytosis of genital skin is a rare clinical manifestation of infection by a common group of pathogens. OBJECTIVE: We emphasize the importance of clinical suspicion and the use of accurate diagnostic methods in the evaluation of deep dermatophytosis. METHODS: We report a single case of tinea pubis, kerion type, caused by Trichophyton mentagrophytes in an immunocompetent host. RESULTS: A 54-year-old female presented with a suppurative infection of the vulva and pubis that was unresponsive to empirical antibiotic therapy. T. mentagrophytes was isolated. Oral itraconazole was initiated on the basis of clinical suspicion and continued for a total of 6 weeks. CONCLUSION: Accurate diagnosis and treatment of deep dermatophytosis of genital skin rests upon proper identification of the pathogen. Prompt initiation of treatment with an oral antifungal agent, such as itraconazole, should be undertaken in order to avoid irreversible scarring alopecia.