Limitations of randomized, controlled, double-blinded studies in determining safety and effectiveness of treatments.

Randomized, controlled, double-blinded studies, in which treated subjects are randomly selected from the same pool as controlled (untreated) ones and neither the caregiver nor the patient knows which is which, are widely accepted as the gold standard of experimental medicine. There are well-documented advantages of such studies. There are, however, significant limitations of them as well of which it is important to be aware. Notably, physicians who rely on experience and on what they were taught in medical school and post-graduate training are not necessarily wrong when this information runs contrary to the results of such studies. Some limitations of them are widely known and taught, such as inadequate sample size, failure of proper randomization, et cetera; others are less well-known. We shall focus on the latter.

Public health issues with Candida auris in COVID-19 patients.

The ongoing pandemic of coronavirus disease 2019 (COVID-19) has overwhelmed a number of medical facilities as well as a few entire health-care systems. A novel issue co-incident with the expeditious deployment of specialty care units for COVID-19 inpatients is the worldwide epidemic of Candida auris infections. Since its first identification and classification in Japan in 2009, it has spread globally. This threat was predicted as C. auris has a high mortality rate, cryptic fomite spread, frequent misidentification since conventional methods do not detect it, and multidrug-resistance. Since the April 2020 warning at the start of the COVID-19 pandemic in the United States, C. auris has been delineated as an increasingly consequential source of significant nosocomial infections, emphasizing the added hazard of C. auris to COVID-19 inpatients, particularly those in intensive care units.

Pyogenic granuloma of the lip - treatment with carbon dioxide slush cryosurgery as an approach in a resource-poor country.

Pyogenic granuloma (PG) is a benign vascular neoplasm most often evident as a rapidly developing solitary, sessile, or polypoid vascular nodule or tumor prone to ulceration or hemorrhage. Bleeding may be episodic, copious, and refractory to pressure, mandating treatment, particularly when on the lip. We describe a 14-year-old adolescent with a PG of the lower lip that responded to carbon dioxide slush cryosurgery, an option that may be of considerable value in a resource-poor country.

Cutaneous leishmaniasis: cryosurgery using carbon dioxide slush in a resource-poor country.

Leishmaniasis is a widespread parasitic disease seen most often in children and young adults, although it may occur at any age. In Yemen, up until now, specific treatment for cutaneous leishmaniasis (CL) has been challenging. Available chemotherapy is expensive and replete with significant side effects. Standard cryosurgery with liquid nitrogen is prohibitively expensive and often unavailable. The objective of this paper is to highlight the importance of cryosurgery with carbon dioxide slush in the treatment of CL in an economically underdeveloped region as a cost-effective, simple, successful, and affordable option.

On being a pathologist: Maria Dabska--the woman behind the eponym, a pioneer in pathology.

There is only one cancer to our knowledge named in honor of its female describer, the Dabska tumor. Maria Dabska was a brave hero of the Warsaw Resurrection of 1944 who survived deportation to Germany to graduate from medical school in Gdansk and pursue a career in pathology, for which her research on the Dabska tumor, breast cancer, sweat gland tumors, keratoacanthoma, soft tissue sarcomas, bone pathology, parachordoma, melanoma, and other entities remains salient. Working behind the Iron Curtain, she nevertheless achieved international recognition, yet few today are cognizant of her and her accomplishments. This vibrant distinguished professor is celebrating her 90th birthday.

Florid cutaneous papillomatosis.

Florid cutaneous papillomatosis is an obligate paraneoplastic syndrome. Originally described by Schwartz and Burgess, and also known as the Schwartz-Burgess syndrome, it is a widespread eruption resembling viral warts yet with no evidence of human papilloma virus infection. We review this entity and its implications.