S-100-negative, GNA11 mutation-positive intramedullary meningeal melanocytoma of the thoracic spine: A radiographic challenge and histologic anomaly.

BACKGROUND: Intramedullary melanocytomas are exceedingly rare and their management is largely based on case reports and small clinical series. They have characteristic imaging and histologic findings that can aid in their diagnosis. Genetic testing may be required for definitive diagnosis and management guidance in ambiguous cases. CASE DESCRIPTION: We present the case of a thoracic intramedullary meningeal melanocytoma in a patient unable to undergo an MRI. CONCLUSION: This is the first reported S-100-negative case with genetic testing to support the diagnosis of a rare intramedullary melanocytoma.

Mycosis fungoides-type cutaneous T-cell lymphoma (MF-CTCL) epidemiology and treatment pathway in Spain: new insights for an accurate description.

BACKGROUND: Mycosis fungoides-type cutaneous T-cell lymphoma (MF-CTCL) is a rare lymphoma localized in the skin. Due to its indolent nature and similarity to other skin conditions, diagnosis is often delayed or incorrect. Consequently, accurate calculations of incidence and prevalence are difficult to make. The treatment pathway taken by MF-CTCL patients can differ depending upon local healthcare systems, clinical policies and guidelines. AIMS: This study aims to (1) provide an estimate for the prevalence of treated MF-CTCL patients in Spain, (2) describe the Spanish patient treatment pathways for MF-CTCL, including quantification of the distribution of patients between primary, secondary and tertiary care institutions, and (3) investigate and quantify the treatment preferences of physicians. METHODOLOGY: This study employed primary market research methodologies to facilitate the collection of patient numbers and treatment practices from healthcare professionals (HCPs) and patients. LIMITATIONS: Poor diagnosis of MF-CTCL may mean that actual prevalence levels in the broader population are higher than those estimated by this analysis of treated patients. This study was reliant upon accurate reporting by HCPs of patient numbers and their personal treatment practices. The rarity of the condition means the patient sample size is relatively small and limits possible accuracy of the quantitative analyses of patient-derived data, although this is supplemented by HCP-derived data in the analysis. FINDINGS: Around 75% of MF-CTCL patients in Spain report that the initial diagnosis by their general practitioner is incorrect. This is usually due to underestimation of severity or type of skin disease. Once they have been correctly diagnosed (usually by a dermatologist) in secondary care, the management of MF-CTCL is led by dermatologists. In 39% of patients, shared care teams are also involved in patient management. Following diagnosis, the majority of patient management is conducted by secondary or tertiary care centers. CONCLUSIONS: Incidence rates have increased in recent years, and possible reasons for this include improving levels of diagnosis. Survival in MF-CTCL has also increased over the last few decades. This trend appears to be reflected in the prevalence reported in this study, which is higher than suggested by some other estimates. However, it is still likely that there are further undiagnosed MF-CTCL patients in Spain due to the challenges of diagnosis at the primary care level.

A comparison of call volumes before, during, and after Hurricane Harvey.

BACKGROUND: There is currently minimal data regarding the demand placed on Emergency Medical Services in the wake of hurricanes and other natural disasters. This retrospective review provides an opportunity to analyze call volumes to EMS and their distribution before, during, and after Hurricane Harvey in one area on the Texas Gulf Coast. OBJECTIVES: Call volumes from Galveston Area Ambulance Authority were reviewed to provide insights for allocation of resources during natural disasters, identifying weaknesses in the current EMS system, and recommending proactive changes for future disasters. METHODS: This study was conducted based on data gathered from the Galveston Area Ambulance Authority which records the call volumes to EMS as well as the paramedics' primary impression of the patients. An analysis of variance (ANOVA) was used to calculate the differences in mean number of calls among the selected days for the periods before, during, and after the hurricane. Also, a paired t-test was used to calculate the difference in means for calls per day and the number calls during the peak days. Statistical significance was set at P ≤ 0.05 with a 95% confidence interval. RESULTS: The 6 days prior to the storm had an average of 48 ±â€¯6 calls, the 6 days during the storm had an average of 50 ±â€¯15 calls, and the 6 days after the storm had an average of 49 ±â€¯14 calls (p = 0.95). The peak number of calls between August 19-September 5 occurred the last 2 days of the storm, into the first 2 days after the storm. The average call volume for these four days was 65 ±â€¯3 calls compared to the average number of calls for the total 18 days which was 49 ±â€¯12 calls (p = 0.008). During the peak days, there were large percentages of calls due to: injury, general pain, respiratory distress, chest pain, and generalized weakness. CONCLUSIONS: EMS and emergency departments can expect peak volumes in the last days of a natural disaster as well as the first few days after the event with increases in injuries, general pain, respiratory distress, chest pain, and generalized weakness. EMS education, proper hospital staffing, and increased telemedicine/community paramedicine usage presents opportunities to increase efficiency in community healthcare during natural disasters.

Depressive symptoms in medical students and residents: a multischool study.

BACKGROUND: This multisite, anonymous study assessed depressive symptoms and suicidal ideation in medical trainees (medical students and residents). METHOD: In 2003-2004, the authors surveyed medical trainees at six sites. Surveys included content from the Center for Epidemiologic Studies-Depression scale (CES-D) and the Primary Care Evaluation of Mental Disorders (PRIME-MD) (measures for depression), as well as demographic content. Rates of reported major and minor depression and of suicidal ideation were calculated. Responses were compared by level of training, gender, and ethnicity. RESULTS: More than 2,000 medical students and residents responded, for an overall response rate of 89%. Based on categorical levels from the CES-D, 12% had probable major depression and 9.2% had probable mild/moderate depression. There were significant differences in depression by trainee level, with a higher rate among medical students; and gender, with higher rates among women (chi2 = 10.42, df = 2, and P = .005 and chi2 = 22.1, df = 2, and P < .001, respectively). Nearly 6% reported suicidal ideation, with differences by trainee level, with a higher rate among medical students; and ethnicity, with the highest rate among black/African American respondents and the lowest among Caucasian respondents (chi2 = 5.19, df = 1, and P = .023 and chi2 = 10.42, df = 3, and P = .015, respectively). CONCLUSIONS: Depression remains a significant issue for medical trainees. This study highlights the importance of ongoing mental health assessment, treatment, and education for medical trainees.