TMG 1 (2014): Pandemic Disease in the Medieval World: Rethinking the Black Death, ed. Monica Green

The plague organism (Yersinia pestis) killed an estimated 40% to 60% of all people when it spread rapidly through the Middle East, North Africa, and Europe in the fourteenth century: an event known as the Black Death. Previous research has shown, especially for Western Europe, how population losses then led to structural economic, political, and social changes. But why and how did the pandemic happen in the first place? When and where did it begin? How was it sustained? What was its full geographic extent? And when did it really end? Pandemic Disease in the Medieval World is the first book to synthesize the new evidence and research methods that are providing fresh answers to these crucial questions. It was only in 2011, thanks to ancient DNA recovered from remains unearthed in London’s East Smithfield cemetery, that the full genome of the plague pathogen was identified. This single-celled organism probably originated 3000-4000 years ago and has caused three pandemics in recorded history: the Justinianic (or First) Plague Pandemic, around 541-750; the Black Death (Second Plague Pandemic), conventionally dated to the 1340s; and the Third Plague Pandemic, usually dated from around 1894 to the 1930s. This ground-breaking book brings together scholars from the humanities and social and physical sci­ences to address the question of how recent work in genetics, zoology, and epi­de­miology can enable a rethinking of the Black Death\u27s global reach and its larger historical significance. It forms the inaugural double issue of The Medieval Globe, a new journal sponsored by the Program in Medieval Studies at the University of Illinois at Urbana-Champaign. This issue of The Medieval Globe is published with the support of the World History Center at the University of Pittsburgh.https://scholarworks.wmich.edu/medieval_globe/1000/thumbnail.jp

Ancillary Therapy and Supportive Care of Chronic Graft-versus-Host Disease: National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: V. Ancillary Therapy and Supportive Care Working Group Report

AbstractThe Ancillary Therapy and Supportive Care Working Group had 3 goals: (1) to establish guidelines for ancillary therapy and supportive care in chronic graft-versus-host disease (GVHD), including treatment for symptoms and recommendations for patient education, preventive measures, and appropriate follow-up; (2) to provide guidelines for the prevention and management of infections and other common complications of treatment for chronic GVHD; and (3) to highlight the areas with the greatest need for clinical research. The definition of “ancillary therapy and supportive care” embraces the most frequent immunosuppressive or anti-inflammatory interventions used with topical intent and any other interventions directed at organ-specific control of symptoms or complications resulting from GVHD and its therapy. Also included in the definition are educational, preventive, and psychosocial interventions with this same objective. Recommendations are organized according to the strength and quality of evidence supporting them and cover the most commonly involved organs, including the skin, mouth, female genital tract, eyes, gastrointestinal tract, and lungs. Recommendations are provided for prevention of infections, osteoporosis, and steroid myopathy and management of neurocognitive and psychosocial adverse effects related to chronic GVHD. Optimal care of patients with chronic GVHD often requires a multidisciplinary approach

A case of radiation-induced bullous morphea/lichen sclerosus overlap in a breast cancer patient

Radiation induced morphea (RIM) is an increasingly common complication of radiation treatment for malignancy as early detection has made more patients eligible for non-surgical treatment options. In many cases, the radiation oncologist is the first person to learn of the initial skin changes, often months before a dermatologist sees them. In this paper we present a breast cancer patient who developed a rare bullous variant of RIM, which delayed her diagnosis and subsequent treatment. It is imperative to diagnose RIM early as it carries significant morbidity and permanent deformity if left untreated. The lesions typically present within 1 year of radiation therapy and extend beyond the radiated field. RIM is often mistaken for radiation dermatitis or cellulitis. Bullae, when present, are often hemorrhagic in appearance, which can serve as another clinical clue. It is important to refer these patients for a full gynecologic exam as there can be concurrent anogenital lichen sclerosus et atrophicus which is both debilitating and carries a long term risk for squamous cell carcinoma. Treatment with systemic agents is often necessary, and can be managed by a dermatologist. The most proven regimen in the literature appears to be methotrexate, with our without concurrent narrow band UVB phototherapy

Cutaneous Manifestations of Chronic Graft-versus-Host Disease

AbstractCutaneous chronic graft versus host disease has traditionally been classified into lichenoid and scleroderma-like forms. However, the initial presentation is sometimes subtle and a variety of less common cutaneous manifestation may be prevalent. This clinical review focuses on the lesional morphology of chronic graft versus host disease, and presents a classification system that may prove useful in early diagnosis. In addition, this approach may help to facilitate the correlation of different morphologic entities with outcome and response to therapy