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1.
JAAPA ; 37(6): 37-41, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38985114

RESUMO

ABSTRACT: Skin cancer is the most common cancer in the United States, with an estimated 9,500 new diagnoses made each day. Dermoscopy (also called dermatoscopy) is an established clinical approach to improving skin cancer evaluation. However, only 8% to 9% of primary care physicians use it, and no data are available for physician associate/assistant or NP use. This article reports a dermoscopy algorithm that primary care providers can use to increase the detection of skin cancer and reduce unnecessary referrals and biopsies.


Assuntos
Dermoscopia , Atenção Primária à Saúde , Neoplasias Cutâneas , Humanos , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Algoritmos , Encaminhamento e Consulta , Melanoma/diagnóstico por imagem , Melanoma/diagnóstico , Melanoma/patologia , Assistentes Médicos , Estados Unidos , Biópsia/métodos
3.
Cureus ; 16(6): e62336, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-39006726

RESUMO

The incidence of nontuberculous mycobacteria infections has surged over recent decades. Mycobacterium abscessus is one example that can present unique diagnostic challenges due to its variable antibiotic resistance profile and its clinical similarities to Actinomycoses israelii in postodontogenic infections. The authors report a case of a 22-year-old healthy female presenting with bilateral mandibular nodules following wisdom teeth extraction. After a presumptive diagnosis of actinomycosis, cultures revealed a Mycobacterium abscessus infection susceptible to macrolides. Magnetic resonance imaging depicted bilateral sinus tracts without osteomyelitis. The patient opted for dual antibiotic therapy, consisting of azithromycin and omadacycline, without surgical intervention. Given her clinical and radiographic improvement after three months, the patient elected to continue dual antibiotic therapy for 12 months with appropriate clinical and radiographic monitoring. This case underscores the importance of early microbial cultures to guide diagnosis and treatment, particularly considering Mycobacterium abscessus's similarities with other pathogens and its variable macrolide susceptibility due to genetic mutations. As highlighted in this case, clinicians must successfully differentiate between and appropriately treat various nontuberculous mycobacteria.

5.
Cureus ; 16(2): e53746, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38465181

RESUMO

Nicolau syndrome is a rare adverse reaction that can occur in the setting of intramuscular, intravenous, and subcutaneous injections. Proper diagnosis and management are critical to avoid complications including abscesses, muscular atrophy, and necrotizing fasciitis. Here, we report a 55-year-old female with multiple sclerosis who presented to our clinic following a subcutaneous injection of 40mg of glatiramer. She immediately noted a sharp pain and erythema, which developed into a purple discoloration, became purulent, and eventually necrosed. The patient's wound was debrided, and she was advised to clean the wound with soap and water, apply topical mupirocin, and change dressings twice daily. She continued to receive appropriate follow-up care with weekly to bi-weekly debridement with excellent resolution.

6.
JAAPA ; 37(2): 1-6, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38230906

RESUMO

OBJECTIVE: This study evaluated the racial and ethnic diversity of physician associate/assistant (PA) graduating cohorts during the profession's transition from a standard undergraduate degree to an entry-level master's degree. METHODS: Using all existing program reports from the Physician Assistant Education Association (1985-2019), we explored potential associations between changes in tuition, degree types offered, and racial/ethnic makeup of graduating cohorts. RESULTS: We observed a strong negative association between Black students and graduates versus increasing tuition and the rise of master's level programs. CONCLUSIONS: More equitable opportunities for joining the PA profession may be needed.


Assuntos
Assistentes Médicos , Estudantes , Humanos , Escolaridade , Assistentes Médicos/educação
8.
Dermatol Online J ; 29(4)2023 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-37921817

RESUMO

Cutaneous larva migrans (CLM) is a dermo-epidermal parasitic infection with a disproportionate incidence in developing countries, particularly in, and near tropical areas. It is characterized by erythematous, twisting, and linear plaques that can migrate to adjacent skin. Herein, we present an otherwise healthy 45-year-old woman who acquired a pruritic, erythematous, and serpiginous rash localized to her right medial ankle during a trip to New England. Oral ivermectin, the preferred first-line treatment for cutaneous larva migrans, was administered in combination with triamcinolone. This was followed by removal of the papular area via punch biopsy; treatment was successful with a one-week recovery. Although cutaneous larva migrans has traditionally been considered a tropical disease, clinicians should be cognizant of its expanding geographic spread.


Assuntos
Exantema , Larva Migrans , Humanos , Feminino , Pessoa de Meia-Idade , Larva Migrans/diagnóstico , Larva Migrans/tratamento farmacológico , Larva Migrans/epidemiologia , Ivermectina/uso terapêutico , Pele/patologia , Epiderme , Exantema/patologia
12.
JAAPA ; 36(9): 8-9, 2023 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-37561657
13.
Dermatol Online J ; 29(1)2023 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-37040917

RESUMO

Bullous impetigo is a variant of epidermal infection by Staphylococcus aureus, representing 30% of impetigo cases. Its clinical appearance may mimic certain autoimmune blistering dermatoses and other cutaneous infections, sometimes necessitating careful evaluation. Herein we present a patient with bullous impetigo in a striking and characteristic appearance and briefly overview the approach to diagnosis, treatment, and prevention.


Assuntos
Doenças Autoimunes , Impetigo , Dermatopatias , Infecções Estafilocócicas , Masculino , Humanos , Impetigo/diagnóstico , Vesícula , Abdome
14.
Arch Dermatol Res ; 315(7): 2027-2033, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36912953

RESUMO

The dermatology workforce includes physicians, nurse practitioners (NPs), and physician associates/assistants (PAs). The number of dermatologists is growing slowly while the growth of PAs working in dermatology is rapid and accelerating. To understand their characteristics, a descriptive study of PAs practicing in dermatology utilizing the National Commission on Certification of Physician Assistants (NCCPA) workforce dataset on PA practices was undertaken. NCCPA certifies PAs who practice in the United States and queries them about their role, employment, salary, and job satisfaction. Analyses consisted of descriptive statistics, Chi-Square, and Mann-Whitney tests for comparisons between PAs practicing in dermatology versus the total of all other PA specialties. As of 2021, 4,580 certified PAs reported practicing in dermatology-a nearly twofold increase since 2013, when 2323 worked in the specialty. This cohort's median age was 39 years, and 82% were female. Almost all (91.5%) are office based, and 81% work more than 31 h per week. The median salary was $125,000 (2020 dollars). Dermatology PAs work fewer hours and see more patients than their counterparts compared to all 69 PA specialties. At the same time, dermatology PAs are more satisfied and less burnt out when compared to all PAs. The increased number of PAs selecting dermatology as their discipline can help lessen the projected physician shortage in this field.


Assuntos
Dermatologia , Profissionais de Enfermagem , Assistentes Médicos , Médicos , Humanos , Estados Unidos , Feminino , Adulto , Masculino , Recursos Humanos
15.
Cutis ; 110(4): E4-E10, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36446091

RESUMO

IgA vasculitis is a form of cutaneous small-vessel leukocytoclastic vasculitis (LCV) that has various triggers, including anti-tumor necrosis factor (TNF) α therapy. As the use of more targeted biologic therapies such as the IL-17 inhibitor secukinumab increases, so do reports of associated adverse events. Herein, we describe an uncommon case of IgA vasculitis in a man undergoing biologic therapy with adalimumab and secukinumab for psoriasis with recurrent cutaneous methicillin-resistant Staphylococcus aureus (MRSA) colonization. A review of the current literature also is provided.


Assuntos
Vasculite por IgA , Staphylococcus aureus Resistente à Meticilina , Psoríase , Vasculite Leucocitoclástica Cutânea , Masculino , Humanos , Psoríase/tratamento farmacológico , Terapia Biológica , Adalimumab/uso terapêutico , Vasculite Leucocitoclástica Cutânea/tratamento farmacológico
17.
Dermatol Online J ; 28(4)2022 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-36259857

RESUMO

Pityriasis rubra pilaris is a papulosquamous inflammatory dermatosis that can be associated with HIV, autoimmunity, infections, certain medications, and neoplasms. Paraneoplastic pityriasis rubra pilaris has previously been reported in association with solid organ malignancies and once with leukemia. Herein, we present an elderly man with paraneoplastic pityriasis rubra pilaris, heralding the diagnosis of low-grade papillary urothelial carcinoma. Our patient's pityriasis rubra pilaris resolved after surgical resection of the tumor.


Assuntos
Carcinoma de Células de Transição , Pitiríase Rubra Pilar , Neoplasias da Bexiga Urinária , Masculino , Humanos , Idoso , Pitiríase Rubra Pilar/diagnóstico , Pitiríase Rubra Pilar/tratamento farmacológico , Neoplasias da Bexiga Urinária/complicações , Neoplasias da Bexiga Urinária/diagnóstico
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