Fingernail Abnormalities After a Systemic Illness.

Examining a patient's nails and understanding nail growth mechanics can provide helpful clues to help treat past injuries or underlying diseases.

Skin-Colored Papules on the Chest.

An otherwise healthy male presents with multiple smooth uniform painless cystic papules scattered across his central chest.

Recalcitrant genital papules.

This patient was initially told he had genital warts, but the appearance of the lesions, and the presence of a rash on his trunk and extremities, suggested another diagnosis.

Seroprevalences of feline leukemia virus and feline immunodeficiency virus infection in cats in the United States and Canada and risk factors for seropositivity.

OBJECTIVE To estimate seroprevalences for FeLV antigen and anti-FIV antibody and risk factors for seropositivity among cats in the United States and Canada. DESIGN Cross-sectional study. ANIMALS 62,301 cats tested at 1,396 veterinary clinics (n = 45,406) and 127 animal shelters (16,895). PROCEDURES Blood samples were tested with a point-of-care ELISA for FeLV antigen and anti-FIV antibody. Seroprevalence was estimated, and risk factors for seropositivity were evaluated with bivariate and multivariable mixed-model logistic regression analyses adjusted for within-clinic or within-shelter dependencies. RESULTS Overall, seroprevalence was 3.1% for FeLV antigen and 3.6% for anti-FIV antibody. Adult age, outdoor access, clinical disease, and being a sexually intact male were risk factors for seropositivity for each virus. Odds of seropositivity for each virus were greater for cats tested in clinics than for those tested in shelters. Of 1,611 cats with oral disease, 76 (4.7%) and 157 (9.7%) were seropositive for FeLV and FIV, respectively. Of 4,835 cats with respiratory disease, 385 (8.0%) were seropositive for FeLV and 308 (6.4%) were seropositive for FIV. Of 1,983 cats with abscesses or bite wounds, 110 (5.5%) and 247 (12.5%) were seropositive for FeLV and FIV, respectively. Overall, 2,368 of 17,041 (13.9%) unhealthy cats were seropositive for either or both viruses, compared with 1,621 of 45,260 (3.6%) healthy cats. CONCLUSIONS AND CLINICAL RELEVANCE Seroprevalences for FeLV antigen and anti-FIV antibody were similar to those reported in previous studies over the past decade. Taken together, these results indicated a need to improve compliance with existing guidelines for management of feline retroviruses.

Seroprevalence of heartworm infection, risk factors for seropositivity, and frequency of prescribing heartworm preventives for cats in the United States and Canada.

OBJECTIVE To determine the seroprevalence of heartworm infection, risk factors for seropositivity, and frequency of prescribing heartworm preventives for cats. DESIGN Prospective cross-sectional study. ANIMALS 34,975 cats from 1,353 veterinary clinics (n = 26,707) and 125 animal shelters (8,268) in the United States and Canada. PROCEDURES Blood samples were collected from all cats and tested with a point-of-care ELISA for Dirofilaria immitis antigen, FeLV antigen, and FIV antibody. Results were compared among geographic regions and various cat groupings. RESULTS Seropositivity for heartworm antigen in cats was identified in 35 states but not in Canada; overall seroprevalence in the United States was 0.4%. Seroprevalence of heartworm infection was highest in the southern United States. A 3-fold increase in the proportion of seropositive cats was identified for those with (vs without) outdoor access, and a 2.5-fold increase was identified for cats that were unhealthy (vs healthy) when tested. Seroprevalence was 0.3% in healthy cats, 0.7% in cats with oral disease, 0.9% in cats with abscesses or bite wounds, and 1.0% in cats with respiratory disease. Coinfection with a retrovirus increased the risk of heartworm infection. Heartworm preventives were prescribed for only 12.6% of cats at testing, and prescribing was more common in regions with a higher seroprevalence. CONCLUSIONS AND CLINICAL RELEVANCE At an estimated prevalence of 0.4%, hundreds of thousands of cats in the United States are likely infected with heartworms. Given the difficulty in diagnosing infection at all clinically relevant parasite stages and lack of curative treatment options, efforts should be increased to ensure all cats receive heartworm preventives.

Cutaneous Granular Cell Tumor on the Arm in a Middle-Aged Man.

Granular Cell Tumors are uncommon, often benign neoplasms that occur primarily in the oral cavity. Granular Cell Tumors have also been reported in breast, gastrointestinal tissues, and less commonly in the dermis of the upper extremities. This is a case presentation of a 44-year-old Caucasian male with an asymptomatic Granular Cell Tumor on his right arm.

Giant Basal cell carcinoma.

Servicemembers are often exposed to extreme environments with sun exposure, often laying the foundation for future skin cancer. Basal cell carcinoma (BCC) is the most common of skin cancers. We present the case of a 36-year-old male active duty Seabee who presents with a left shoulder plaque that initially started as an erythematous papule but has now increased to greater than 6 cm in the past 10 years and is diagnosed as giant basal cell carcinoma (GBCC). Although only 0.5% to 1% of BCCs develop into GBCCs, there is the potential for metastasis and even death. This article addresses the concerning and potentially fatal diagnosis of GBCC, including your initial impressions and differential diagnoses, available treatment options, and ways to prevent it from ever occurring in our military population.

Stubborn hand rash.

Was there a connection between the rash on this patient's hand and another condition he occasionally suffered from?

The nonhealing scar.

Pyogenic granulomas are common benign skin growths often present at sites of trauma. They can be difficult to treat in austere environments. A case report of a pyogenic granuloma in an austere environment has not previously been published. We submit this work to describe a case of a pyogenic granuloma arising from a properly treated laceration in an austere environment and to review current treatment options. Multiple treatment modalities are available to providers with limited resources to include topical Imiquimod, ethanol injection, silver nitrate application, and oral steroids.

Health effects of ultraviolet irradiation in asthmatic children's homes.

OBJECTIVE: Centrally installed ultraviolet (UV) irradiation units were investigated to determine the potential health benefits in mold-sensitized asthmatic children. METHODS: Nineteen mold-sensitized asthmatic children 5 to 17 years of age with home central ventilation systems were enrolled in a 28-week double-blinded placebo controlled cross-over trial. Clinical outcome measurements included morning and evening peak expiratory flow rates (PEFR), PEFR variability, change in forced expiratory volume in 1 second (FEV1), change in total rhinoconjunctivitis and asthma symptom scores, change in rhinoconjunctivitis and asthma quality-of-life scores, and total (rescue and controller) medication use from baseline and between time periods. Environmental outcomes included changes in temperature, relative humidity, dew point, and indoor airborne mold and bacterial counts from baseline and between time periods. Analysis of variance (ANOVA) and regression analysis and t test were used to evaluate relationships between environmental exposure(s) and clinical outcome measurements during each study period. RESULTS: Twelve male and seven female children, average age 10.6 years, were enrolled. A statistically significant improvement in PEFR variability in subjects receiving CREON2000 units followed by placebo units was observed (p < 0.05) across both treatment periods. Within group analysis during treatment period 1, a statistically significant improvement in reduction of asthma symptom scores, the number of days with asthma symptoms, total asthma medication use, and PEFR variability were observed in subjects receiving CREON2000 units versus placebo units (p < 0.05). No significant differences were observed between the CREON 2000 and placebo units for other clinical or environmental outcome measurements. CONCLUSIONS: Central UV irradiation was effective at reducing airway hyperresponsiveness manifested as PEFR variability and some clinical symptoms. A larger cohort controlled longitudinal study to validate the clinical health effects of UV irradiation as a primary indoor environmental intervention for allergic asthma is necessary to confirm this finding.

Characterization of a population presenting with suspected mold-related health effects.

BACKGROUND: Numerous epidemiologic studies have reported a relationship between dampness and increased respiratory symptoms in adults and children, which has led to increasing concerns among the general population about potential mold-related health effects. OBJECTIVE: To identify characteristics of patients with possible mold-related health effects that might help allergists better understand how to evaluate such patients in their practices. METHODS: The parameters that were evaluated for the total population included age, sex, upper and lower respiratory tract symptoms, systemic symptoms, atopic status, pet ownership, smoking history, mold sensitization, mold exposure, and exposure location. Subgroups stratified by atopic status, mold sensitization, and indoor mold exposure confirmed by an environmental mold report prepared by certified industrial hygienists were also analyzed. Significant associations were determined by correlation coefficients and logistic regression analysis. RESULTS: A total of 135 patients with possible mold-related health effects secondary to prolonged indoor mold exposure were evaluated. For the overall population, a strong correlation was found among atopy, mold sensitization, and sensitization to specific molds identified in the patient's environmental report. Mold intracutaneous testing was not useful for discriminating between atopic and nonatopic individuals. There were no associations among the patients' presenting symptoms, atopic status, and magnitude of mold exposure. Similar findings were identified when subgroup analysis was performed. CONCLUSIONS: Patients who present with mold-related health effects manifest heterogeneous characteristics. Medical history, skin testing, and current indoor mold sampling practices have significant limitations in establishing a causal link among mold exposure health effects.