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Granuloma annulare (GA) is a benign inflammatory dermatosis characterized clinically by dermal papules and annular plaques. The pathogenesis of GA is not well understood, although it is thought to result from a delayed-type hypersensitivity reaction in which inflammatory cells elicit connective tissue degradation. This condition has been seen following the use of several drugs, including tumor necrosis factor-alpha (TNF-α) inhibitors, which paradoxically have also been reported to treat GA. We report the case of a patient who developed GA in association with secukinumab, an interleukin-17A antagonist, and discuss its implications for our understanding of the pathogenesis of GA. [ABSTRACT FROM AUTHOR]

The Krebs Cycle is a highly taught biochemical pathway that is traditionally difficult to learn. Twenty-seven undergraduate students were randomized to a rote memorization arm or to a mnemonic arm. They were given a pre-test, then shown a lecture corresponding to their assigned method, and then given an immediate Week 0 post-test and a Week 4 post-test. Groups scored comparably low on the pre-test ( p = 0.7113). Students in the mnemonic arm performed better on the Week 0 post-test than those using rote ( p = 0.0055). By Week 4, there was evidence of knowledge decay, with both arms' having comparably low scores (mnemonic vs. rote, p = 0.3739). The mnemonic assists in rapid acquisition of knowledge but probably has to be reviewed iteratively over time to demonstrate its full potential over rote memorization. A limited number of students from only one school was used. © 2016 by The International Union of Biochemistry and Molecular Biology, 44:224-229, 2016. [ABSTRACT FROM AUTHOR]

Background Safe venepuncture technique is a critical skill for health care professionals, to avoid accidental occupational injury. This study investigates whether watching an instructional video improves medical students' ability to perform venepuncture safely. Methods This was a randomised, controlled, assessor-blinded trial that evaluated the utility of an instructional video, with the primary outcome of the ability to perform venepuncture safely. Forty-two second-year medical students were recruited and randomised to receive either video instruction (group A, n = 20) or no intervention (group B, n = 22). Prior to the study, all students attended an instructor-led workshop on venepuncture. During the study, students were paired and instructed to perform venepuncture on a partner. Performance was assessed using a points-based checklist. Pre- and post-study surveys were conducted to assess confidence with technique. Results The mean total checklist score was higher in group A than in group B, with values of 14.15 and 9.18, respectively (p < 0.0001, maximum 18 points). Mean scores were also higher in group A than in group B among students who performed first (p = 0.008) and students who performed second (p = 0.005) within the pair. From the post-procedure survey, only group A rated increased confidence in performing venepuncture after the study (p = 0.008). Discussion Students who watched an instructional video performed venepuncture more effectively and reported greater confidence with the technique. Medical students can benefit from having access to an instructional video on venepuncture as an adjunct to the standard curriculum. [ABSTRACT FROM AUTHOR]

Background There are few published guidelines that describe the forethought and logistical considerations needed to create a dermatology-specific medical mission. Objective To report the experience of planning and executing a successful medical mission to an underserved community in Puerto Rico. Methods We identified an area of need and projected the volume of patients and diseases to be treated. After recruiting medical staff, pharmaceutical and surgical supplies were collected. Important concerns included establishing the scope of medical and educational services to be rendered, advertising the clinic, arranging for biopsy processing, ensuring follow-up, and selecting a method for medical documentation. We tracked the number of patients seen, diagnoses made, and materials used to prepare for future missions. Results We recruited 12 physicians and 25 ancillary (i.e. nonlicensed physician) staff members, including: six dermatologists, four internists, one pathologist, one psychiatrist, 23 medical students, and two medical assistants. We secured 12 examination rooms in an existing medical facility. Two pharmaceutical companies and two pathology companies provided the medications and surgical supplies with the remainder coming from the volunteer physicians' offices. Three thousand dollars were raised and used toward purchasing additional supplies. Advertising via public announcements resulted in the attendance of 166 patients during the 1-day clinic. A total of 41 procedures were performed, including 14 biopsies, five excisions, three incisions and drainage, and 19 electrodessications and curettage. Conclusion Proper planning is critical in creating a successful dermatology mission. Documenting the care given and supplies used helps to identify needs and optimize limited resources for future missions. The goal of a self-sustaining public health service starts with patient education and coordination with the local healthcare providers. [ABSTRACT FROM AUTHOR]

Lindane is an organochloride pesticide, first introduced as a scabicide for human use in the 1950s (1). Because of its low cost and efficacy, it quickly became a first-line treatment for scabies and head lice, but not long after its use became widespread, its safety was called into question, primarily regarding its neurotoxic effects. We intend to show through review of the literature and databases that lindane has been associated with numerous severe and fatal adverse reactions. This review will summarize 67 cases of adverse reactions and deaths associated with the medical use of lindane. Many of the most serious events and fatalities occurred in pediatric and geriatric populations. We concede that toxicity frequently arises from misuse, but labeled usage of lindane caused 43% of the serious adverse reactions of this review. Moreover, the numerous instances of lindane misuse elucidate the importance of clear labeling and instructions, especially with a product with a narrow therapeutic index. Therefore, this report attempts to elucidate the dangers of lindane as a medical treatment for scabies and head lice by providing a comprehensive review of all documented adverse drug reactions since its introduction. [ABSTRACT FROM AUTHOR]

Head lice are transmitted by head to head contact. Optimal therapy includes malathion lotion 0.5% repeated in one week left on for 30 minutes to 8 hours. Spinosad topical suspension 0.9% repeated in one week left on for 10 minutes is another option. Scabies is transmitted mainly by direct contact but also via heavily infested fomites due to crusted scabies. Permethrin 5% cream to the body repeated in four days is often sufficient; however, scalp treatment with malathion lotion 0.5% is helpful in crusted scabies and in infested children. Oral ivermectin 200 mcg/kg is another option, repeated in four days. For scabies more than lice, fomites should be placed in a drier at 60 °C for 10 minutes to kill the arthropods. Treatment of close contacts in both cases will control outbreaks and repeated infestations. Both have been associated with methicillin-resistant Staphylococcus aureus infection. Bed bugs are a common cause for papular urticaria. Identification of the insect in the mattress or bedding confirms the diagnosis. Prevention involves encasing the mattress in a sealed plastic cover and extermination. Delusions of parasitosis is a diagnosis of exclusion that is best treated with an antipsychotic. [ABSTRACT FROM AUTHOR]

Background. There are relatively few studies published examining the sensitivity and specificity of potassium hydroxide (KOH) smear and fungal culture examination of tinea pedis. Objective. To evaluate the sensitivity and specificity of KOH smear and fungal culture for diagnosing tinea pedis. Methods. A pooled analysis of data from five similarly conducted bioequivalence trials for antifungal drugs was performed. Data from 460 patients enrolled in the vehicle arms of these studies with clinical diagnosis of tinea pedis supported by positive fungal culture were analyzed 6 weeks after initiation of the study to determine the sensitivity and specificity of KOH smear and fungal culture. Results. Using clinical assessment as the gold standard, the sensitivities for KOH smear and culture were 73.3% (95% CI: 66.3 to 79.5%) and 41.7% (34.6 to 49.1%), respectively. The respective specificities for culture and KOH smear were 77.7% (72.2 to 82.5%) and 42.5% (36.6 to 48.6%). Conclusion. KOH smear and fungal culture are complementary diagnostic tests for tinea pedis, with the former being the more sensitive test of the two, and the latter being more specific. [ABSTRACT FROM AUTHOR]

The following tips are suggested for phototherapy: (i) calibrate the unit with a radiometer every 2-4 weeks; (ii) change all bulbs at the same time every 8-10 months for regularly used machines or when the UV meter shows that the power has reached 3 or 4 mW/cm2; (iii) avoid phototherapy sessions on consecutive days to prevent burn on burn; (iv) in the event of a burn, reduce the last PUVA or UVB dose by 50%, reinitiating when erythema has fully disappeared, which might take two days to two weeks; (v) nausea from oral psoralens can be avoided by taking it with a fixed amount of milk or food, taking an antiemetic with this meal prior to dosing, taking five ginger tablets 15 minutes before dosing, or dividing the dosage; (vi) to achieve 0.03% concentration of 8-methoxypsoralen for hand and foot soak PUVA, dissolve a 10-mg tablet or 1.0 cc of Oxsoralen® solution 1% in 3 l of water; and (vii) to achieve 0.000075% concentration of 8-methoxypsoralen for full-body soak PUVA, dissolve 60 mg 8-methoxypsoralen in 80 l of water (i.e. a bath tub). [ABSTRACT FROM AUTHOR]

A 44-year-old Hispanic man, with a past medical history of diabetes mellitus type 2 and cerebrovascular accident, presented to the Mount Sinai Department of Dermatology with sudden, fast-growing nodules over both of his shins. Approximately 2 months before the appearance of the nodules, the patient was diagnosed with diabetes mellitus type 2 with hemoglobin A1c (HbA1c ) of 8.5%. The patient was taking metformin orally, 500 mg three times daily, at the time of presentation. Six nodules appeared over a period of days. They caused a burning, throbbing pain upon ambulation. Over a period of 6 months, the lumps decreased in size, and two totally disappeared. The resolution of the nodules coincided with the control of the patient's diabetes, as demonstrated by HbA1c of 5.5%. The patient denied trauma to the sites of the nodules. The patient denied any associated purpura or ecchymoses over the nodules. The past medical history was significant for a stroke with residual right hemiparesis at 42 years of age. The family history was negative for similar lesions, but an aunt did have diabetes mellitus type 2. The patient denied alcohol use, smoking, or intravenous drug use. Physical examination was positive for six soft, tender, freely mobile, symmetrical, well-demarcated, round masses, 1–2 cm in diameter and skin colored, over the anterior aspects of both legs. The patient was obese (body mass index, 38.5). Laboratory tests (barring the initially elevated HbA1c ) were normal. One lesion was excised. Histopathology revealed features typical of an angiolipoma (see Fig. 1a,b). A karyotype of the angiolipoma was not performed. Because excision of one angiolipoma produced scarring with a poor cosmetic result, intralesional triamcinolone, 5 mg/mL, was tried without success. [ABSTRACT FROM AUTHOR]

Background While serological studies are the primary tool used to confirm the diagnosis of secondary syphilis, skin biopsies are often performed to control for potential false positives and negatives. Immunohistochemistry using anti- T. pallidum specific antibodies has proven to have a very high sensitivity and specificity for identification of spirochetes in biopsy specimens, but can occasionally fail to identify organisms in clinically and serologically confirmed cases. Methods We report two cases of apparently negative biopsy specimens in which rare organisms were subsequently identified by detailed study of multiple additional sections. Results Our experience suggests that the sensitivity of immunohistochemistry for syphilitic spirochetes may be improved by repeat immunostaining. [ABSTRACT FROM AUTHOR]

This article presents response of the author to the article published by research scientist of Canada Darryl Stout in the journal "Plant, Cell and Environment." The major points in Stout's article are that (1) under natural or slow rates of freezing, plasma membrane permeability does not significantly limit water efflux from plant cells and (2) water efflux at slow freezing rates is controlled largely by the rate of heat removal from the plant cells. The author emphasized that the second point cannot possibly explain intracellular freezing, since when rate of heat removal is limiting, this must slow down the rate of freezing and, therefore, it can favour extracellular freezing but cannot be a factor in intracellular freezing.