Eruptive Lentigines Confined to Resolving Psoriatic Plaques Following Treatment with Guselkumab

Eruptive lentigines in the area of resolving psoriatic plaques has been well documented in the literature following successful treatment with multiple therapies. This is historically associated with light treatment but has been expanded to include other therapies such as anti-tumor necrosis factor therapies and, more recently, some biologics5. Guselkumab (Tremfya) is an IgG1λ monoclonal antibody used in the treatment of plaque psoriasis with only one case of eruptive lentigines confined to resolving psoriatic plaques (ELRP) noted as a side effect. We present the second such case of ELRP associated with successful treatment of plaque psoriasis with Guselkumab, as it is important to document potential side effects of medications regardless of their severity

The Expansion of Lyme Disease: A Case of Infection in the Absence of Known Exposure

Lyme disease is a systemic infection caused by the spirochete Borrelia burgdorferi often carried the Ixodes tick. It is associated with dermatologic manifestations, most notably the “bullseye rash” of erythema migrans. The disease can progress in stages to involve other organs such as joints, heart, and the nervous system. Lyme disease is continuing to spread, with West Virginia cases increasing dramatically in the last 2 decades. As a result, physicians are likely to encounter this disease more often, making recognition and early treatment a top priority in order to prevent potentially dangerous sequelae. We present a case of a 60-year-old man who presented with multiple erythematous annular plaques and was subsequently diagnosed with Lyme disease. He had no known exposure to ticks, was treated for Lyme Disease, and subsequently developed a Jarisch- Herxheimer reaction (JHR)

Smartphone Mobile Application to Enhance Diagnosis of Skin Cancer: A Guide for the Rural Practitioner

Primary care physicians occupy a vital position to impact many devastating conditions, especially those dependent upon early diagnosis, such as skin cancer. Skin cancer is the most common cancer in the United States and despite improvements in skin cancer therapy, patients with a delay in diagnosis and advanced disease continue to have a grave prognosis. Due to a variety of barriers, advanced stages of skin cancer are more prominent in rural populations. In order to improve early diagnosis four things are paramount: increased patient participation in prevention methods, establishment of screening guidelines, increased diagnostic accuracy of malignant lesions, and easier access to dermatologists. Recent expansion in smartphone mobile application technology offers simple ways for rural practitioners to address these problems. More than 100,000 health related applications are currently available, with over 200 covering dermatology. This review will evaluate the newest and most useful of those applications offered to enhance the prevention and early diagnosis of skin cancer, particularly in the rural population

Two-vessel off-pump coronary artery bypass grafting by left thoracotomy in a complex redo case

Introduction: The left thoracotomy approach is an alternative technique for coronary revascularization to avoid complications associated with re-sternotomy, such as injury to patent grafts, right ventricle, aorta, during re-sternotomy. Situations such as calcification of the ascending aorta and previous mediastinitis favor the use of the left thoracotomy approach. Revascularization of the circumflex territory via a lateral thoracotomy has been reported previously. However, reports of revascularization of the LAD combined with circumflex artery territory via left thoracotomy approach are rare. We successfully performed an off-pump CABG by left thoracotomy in a complex redo case to revascularize the LAD and obtuse marginal branch (OM) in an 83 year-old-man who had CABG and AVR in the past with a heavily calcified ascending aorta. Case Report: 83-year-old caucasian male History of CABG 20 years ago, redo CABG in the following year due to graft failure, and an AVR with a mechanical valve 12 years ago, and multiple coronary interventions. Presented with unstable angina. Echo showed normal LV function Due to his history of early stent re-stenosis and location of the disease, he was considered not suitable for repeat PCI. CT Scan showed severe calcification of the ascending aorta (left), and mild disease on the descending aorta. Presented at Chest 2013. Chicago IL.October 26-31, 2013

The psychometric properties of the Smartphone Application-Based Addiction Scale (SABAS)

The goal of the study was to validate the English version of the Smartphone Application-Based Addiction Scale (SABAS; Csibi et al. 2016), which is a short and easy-to-use tool for screening the risk of smartphone application-based addiction. Another aim was to identify the most frequently used smartphone applications and their perceived importance by the participants. Data were collected online from 240 English-speaking volunteers, aged 18 to 69 years. The instruments used were the SABAS, the Nomophobia Questionnaire (NMP-Q), the Brief Sensation Seeking Scale (BSSS), the Deprivation Sensation Scale (DSS), and the Patient Health Questionnaire (PHQ- 9). Participants also ranked the importance of their most frequently used smartphone applications. The six items of the SABAS yielded one component, which accounted for 52.38% of the total variance. The internal reliability of the scale was good (Cronbach’s alpha 0.81). NMP-Q was a significant predictor of SABAS, explaining 17.6% of the total variance. The regression analysis, with SABAS score as the dependent variable and NMP-Q, DSS, PHQ-9, and BSSS scores as predictors, indicated that approximately 47% of the variance in SABAS was accounted for by the predictors (R2 = 0.47). The English version of the SABAS appears to be a valid and reliable ultra-brief tool for a quick and easy assessment of smartphone application-based addiction symptoms

Generalized Query-Based Active Learning to Identify Differentially Methylated Regions in DNA

Active learning is a supervised learning technique that reduces the number of examples required for building a successful classifier, because it can choose the data it learns from. This technique holds promise for many biological domains in which classified examples are expensive and time-consuming to obtain. Most traditional active learning methods ask very specific queries to the Oracle (e.g., a human expert) to label an unlabeled example. The example may consist of numerous features, many of which are irrelevant. Removing such features will create a shorter query with only relevant features, and it will be easier for the Oracle to answer. We propose a generalized query-based active learning (GQAL) approach that constructs generalized queries based on multiple instances. By constructing appropriately generalized queries, we can achieve higher accuracy compared to traditional active learning methods. We apply our active learning method to find differentially DNA methylated regions (DMRs). DMRs are DNA locations in the genome that are known to be involved in tissue differentiation, epigenetic regulation, and disease. We also apply our method on 13 other data sets and show that our method is better than another popular active learning technique

Assessment of Emergency Medicine Resident Performance in an Adult Simulation Using a Multisource Feedback Approach.

Introduction: The Accreditation Council for Graduate Medical Education (ACGME) specifically notes multisource feedback (MSF) as a recommended means of resident assessment in the emergency medicine (EM) Milestones. High-fidelity simulation is an environment wherein residents can receive MSF from various types of healthcare professionals. Previously, the Queen\u27s Simulation Assessment Tool (QSAT) has been validated for faculty to assess residents in five categories: assessment; diagnostic actions; therapeutic actions; interpersonal communication, and overall assessment. We sought to determine whether the QSAT could be used to provide MSF using a standardized simulation case. Methods: Prospectively after institutional review board approval, residents from a dual ACGME/osteopathic-approved postgraduate years (PGY) 1-4 EM residency were consented for participation. We developed a standardized resuscitation after overdose case with specific 1-5 Likert anchors used by the QSAT. A PGY 2-4 resident participated in the role of team leader, who completed a QSAT as self-assessment. The team consisted of a PGY-1 peer, an emergency medical services (EMS) provider, and a nurse. Two core faculty were present to administer the simulation case and assess. Demographics were gathered from all participants completing QSATs. We analyzed QSATs by each category and on cumulative score. Hypothesis testing was performed using intraclass correlation coefficients (ICC), with 95% confidence intervals. Interpretation of ICC results was based on previously published definitions. Results: We enrolled 34 team leader residents along with 34 nurses. A single PGY-1, a single EMS provider and two faculty were also enrolled. Faculty provided higher cumulative QSAT scores than the other sources of MSF. QSAT scores did not increase with team leader PGY level. ICC for inter-rater reliability for all sources of MSF was 0.754 (0.572-0.867). Removing the self-evaluation scores increased inter-rater reliability to 0.838 (0.733-0.910). There was lesser agreement between faculty and nurse evaluations than from the EMS or peer evaluation. Conclusion: In this single-site cohort using an internally developed simulation case, the QSAT provided MSF with excellent reliability. Self-assessment decreases the reliability of the MSF, and our data suggest self-assessment should not be a component of MSF. Use of the QSAT for MSF may be considered as a source of data for clinical competency committees