The use of drug calendars for the diagnosis of cutaneous drug eruptions in the age of electronic medical records

A morbilliform drug eruption is the most common condition leading to a dermatology consultation for a patient in the hospital. Timing is an important diagnostic tool since the onset of a skin rash usually takes place within days-to-weeks of the start of the implicated drug. A comprehensive, thorough, and reliable drug history by the clinician is essential. Therefore, to assist in the task of determining the causative medication of a new skin rash in a hospitalized patient, the creation of a drug calendar is recommended. The development of an electronic version of the drug calendar offers several benefits over the manual version. As the use of electronic medical records continues to become the standard in medicine, the electronic drug calendar will serve as an invaluable tool for the diagnosis of drug hypersensitivity

DIPL 6195 Creating a 21st Century Diplomacy

The practice of diplomacy is rapidly changing. The historic profession of representing nation states has collided with the 24-hour media cycle, terrorism, globalization, climate change, proliferation, disease, changes in demography and stresses on those institutions which still dominate the post- 1945 landscape. What will need to change if diplomats are to help meet the challenges of the 21st century? Our work together will consider what should define 21st century diplomatic practice. We will then try to apply ideas for change through presentations, role-plays and written work. Success will require regular attendance, doing the assigned readings, preparing an oral presentation, actively participating in the role-play/simulations and completing and turning in on time the three types of written assignments. In accordance with Seton Hall’s procedures, students with disabilities should contact Disabilities Support Services for special accommodations

A Case of Steroid-Responsive Encephalopathy

Hashimoto\u27s encephalopathy (HE), also known as steroid-responsive encephalopathy, is associated with autoimmune-mediated thyroiditis. Onset is typically gradual often with evolution over the course of months. Characteristic symptoms include impaired concentration and memory, delusions, hallucinations, personality changes, incoordination, tremor, hemiparesis, seizures, and speech difficulties. Diagnosis is predicated upon discovery of elevated anti-thyroid antibodies, specifically anti-thyroid peroxidase (TPO) or anti-M antibodies. Some patients may also present with subclinical hypothyroidism but many are euthyroid. Of note, neither thyroid function tests or antibody titers correlate with disease severity. Other common laboratory findings include elevations in sedimentation rate, liver enzymes, and cerebrospinal fluid (CSF) protein. Radiological work-up, including cerebral angiography, is often normal. Successful treatment includes administration of steroids and/or intravenous immunoglobulin (IVIg) or plasmapheresis. We describe a case of a 74-year-old male who presented for evaluation of abrupt onset confusion ultimately determined to be a consequence of autoimmune-mediated thyroiditis

Herpetic zoster folliculitis in the immunocompromised host

Introduction Exclusive involvement of herpes zoster (HZ) in the follicular epithelium occurs rarely and lacks the typical cutaneous and histopathologic findings associated with herpesvirus. We describe a patient who underwent adjuvant chemotherapy for pancreatic cancer and subsequently had a nonvesicular rash for several weeks, ultimately proving to be herpetic zoster folliculitis. Case report A 78-year-old man with adenocarcinoma of the tail of the pancreas treated with surgical resection and 1 round of adjuvant chemotherapy with gemcitabine, docetaxel, and capecitabine presented with a 3-week history of a right leg rash. He first noticed the rash 5 days after the initiation of his chemotherapy. It initially appeared on his middorsal foot, and over the next couple weeks progressed proximally along the anteromedial leg to the distal knee and medial thigh. It was not painful and was minimally pruritic. Two and a half weeks after the onset of his rash, a fever to 38.5°C developed along with back pain. At this time, he had a nondiagnostic skin biopsy by an outside dermatologist and was given diphenhydramine and topical hydrocortisone with no improvement in his rash. He also had an abdominal computed tomography (CT) performed at an outside hospital, which found a left upper quadrant fluid collection. He was subsequently admitted to Columbia Presbyterian Medical Center for evaluation. On our examination, he had purpuric patches and edematous, purpuric papules along the right dorsal foot, extending proximally up the right anteromedial leg (Fig 1). He also had a few faint pink papules along the right hip and superior buttock (Fig 2). There were no vesicles. A comprehensive metabolic panel and liver function test results were normal. Noted were a leukocytosis level of 14,400/μL with 76% neutrophils and 1% bands, an elevated lipase level of 194 U/L (3-43 U/L), and an amylase level of 95 U/L (20-96 U/L). A CT scan of the abdomen confirmed an 8.0- × 7.0-cm fluid collection of the left upper quadrant of the abdomen. A skin biopsy of the right anteromedial leg found only alteration of the basal layer epidermis with a perivascular mononuclear cell infiltrate and extravasated erythrocytes. However, deeper sections had necrotic keratinocytes and multinucleated epithelial-type giant cells with ground-glass nuclei restricted to the follicular epithelium, confirming a diagnosis of follicular herpetic infection (Fig 3, A and B). A diagnosis of HZ in the L4 and L5 dermatomes was made, and the eruption promptly resolved with a 7-day course of valganciclovir (1-g tablet 3 times a day)

Resolution of urticarial vasculitis after treatment of neurocysticercosis

Urticarial vasculitis is most often idiopathic, but may occur in association with autoimmune disease, malignancy, drugs, or infection. Parasitic infection is a rare cause of urticarial vasculitis. We report a case of urticarial vasculitis that resolved after the diagnosis and treatment of neurocysticercosis

Civil conflict, federalism and strategic delegation of leadership

This article analyzes negative externalities that policymakers in one region or group may impose upon the citizens of neighboring regions or groups. These externalities may be material, but they may also be psychological (in the form of envy). The latter form of externality may arise from the production of 'conspicuous' public goods. As a result, decentralized provision of conspicuous public goods may be too high. Potentially, a centralized legislature may internalize negative externalities. However, in a model with strategic delegation, we argue that the median voter in each jurisdiction may anticipate a reduction in local public goods supply and delegate to a policymaker who cares more for public goods than she does herself. This last effect mitigates the expected benefits of policy centralization. The authors' theory is then applied to the setting of civil conflict, where they discuss electoral outcomes in Northern Ireland and Yugoslavia before and after significant institutional changes that affected the degree of centralization. These case studies provide support for the authors' theoretical predictions

Baryon Triality and Neutrino Masses from an Anomalous Flavor U(1)

We construct a concise U(1)_X Froggatt-Nielsen model in which baryon triality, a discrete gauge Z_3 symmetry, arises from U(1)_X breaking. The proton is thus stable, however, R-parity is violated. With the proper choice of U(1)_X charges we can obtain neutrino masses and mixings consistent with an explanation of the atmospheric and solar neutrino anomalies in terms of neutrino oscillations, with no right-handed neutrinos required. The only mass scale apart from M_grav is m_3/2 ~ m_soft.Comment: matches published version, typos corrected, references added, 54 pages, 3 figures, 5 table