Protection from harmful ultraviolet radiation (UVR) can be achieved in a multitude of ways: sunscreen, chemical laundering additives, regular clothing, and photoprotective clothing. While sunscreen remains a popular sun-protective method, research has shown that its long-term use can lead to serious neurological, endocrine, and developmental consequences. Chemical laundering additives have been marketed as a means to absorb or reflect UVR, but data on its efficacy tests are not currently available, and skin contact with these chemicals may prove to be harmful. All clothing, regular or sun-protective, confers sun protection through dyes, weave patterns, and textile materials. However, photoprotective clothing is generally rated as more protective on the ultraviolent protection factor (UPF) scale and garment protection factor (GPF) scale. A combination of photoprotective clothing and sunscreen use over non-covered body areas is likely to be the optimal way for sun protection with minimal risk. However, further research on the topic is needed to gain deeper insights into it.
BACKGROUND The treatment of nonmelanoma skin cancer (NMSC) in the elderly population is a source of significant debate. Mohs micrographic surgery (MMS) is a highly effective treatment option yet not every patient with a cutaneous malignancy that meets appropriate use criteria (AUC) should be treated with surgery. OBJECTIVE The purpose of this study was to use the Karnofsky Performance Status (KPS) scale to categorize the functional status of patients aged 75 years and older who required treatment of NMSC. The authors wanted to see whether functionality played a role on the treatment selection. METHODS Patients aged 75 years and older presenting for biopsy of a suspected NMSC that met AUC for MMS were included in the study. Trained medical assistants used the KPS scale to assess patient functionality. Treatment modality was recorded once the biopsy confirmed the NMSC. RESULTS A cohort of 203 subjects met inclusion criteria for the study. There was a statistically significant difference in utilization of surgical treatments between high and low functionality patients (p = .03). CONCLUSION Dermatologists consider patient functionality when selecting a treatment for NMSC and use less invasive modalities for patients with poor functional status, even when the tumor meets AUC.
Primum non nocere", "first do no harm" is a medical dictum based in antiquity. Yet, in nearly everything related to Lyme disease, it seems almost entirely disregarded. How ethical is it that we follow the guidelines of the CDC regarding diagnosis when those guidelines require erythema migrans that is clearly recognizable only in one ("bullseye rash") of its multiple presentations? Further, how ethical is it that we are held to guidelines regarding a positive serology that is positive (at best) only 40% of the time? Another questionable ethical situation is the use of a bacteriostatic antibiotic that barely meets the MIC for Borrelia burgdorferi in its ordinarily prescribed regimen. It is also dependent on compliance which is a huge issue because of the gastrointestinal side effects. This antibiotic may clear the rash, but seemingly does little to prevent late findings of the disease. The sub lethal antibiotic dose can be important in the subsequent development of biofilms that lead to a chronic disease state. Lastly, how ethical is it that we have nearly abandoned our patient advocacy and permitted the insurance companies to dictate allowable treatment? And, in as much as Borrelia organisms were found in the brains of Alzheimer's disease patients over 25 yrs ago and those spirochetes have recently been shown to produce biofilms, how ethical is it that we ignore research underpinning the pathogenesis of this disease? The intent of this work is to discuss how all aspects of Lyme disease (LD) are bioethically challenged. We include Alzheimer's disease (AD) in the discussion because Lyme spirochetes have been found in, and cultured from, the brains of AD. This makes LD, in its presentation as AD, the equivalent of tertiary neurosyphilis with the only difference being a different spirochete.
Introduction: Abnormal uterine bleeding (AUB) can occur at any age in a woman’s life, and it is more prevalent in the premenopausal age group. Although anovulation is the most prevalent endometrial cause, other major reasons include endometrial hyperplasia, endometrial adenomatous polyps and cancer. For patients of all ages, it is one of the most prevalent presentations in Gynecology OPDs. AUB has a major impact on health-related quality of life, necessitating quick intervention. AUB treatment is difficult without a good diagnosis. As a result, pre-menopausal and post-menopausal women with AUB must have a thorough examination to rule out endometrial cancer. Aim: To assess the role of transvaginal ultrasound and color Doppler tomography (CDTU) in irregular uterine bleeding and correlate these findings with histological diagnosis. Methodology: The present study included 92 individuals with abnormal uterine bleeding (AUB), in those TVS, and Color Doppler was used to evaluate the endometrial pathologies. Endometrium, uterine size and any uterine or adnexal disease were evaluated during the TVS. Spiral arteries of the endometrium and uterine arteries were studied for their vascular patterns. The RI and PI of the uterine artery were determined. For PI, a cutoff of 1.83 was used, while for RI, a cutoff of 0.81 was used. The results were then compared to endometrial histology. Results: According to TVS, (see Table 1) the most common causes of AUB were leiomyoma (15.2%), polyp (12%), PCOS (9.8%), adenomyosis (5.43%) and endometrial development (3.3%). The uterine indicators of RI (0.81) and PI (1.83) of the uterine artery by CDTU revealed 11 patients with probable cancer. For AUB M, the TVS with CDTU specificity and sensitivity was 100 percent and 90.77 percent, respectively. The positive predictive value was 45%, whereas the negative predictive value was 100%. Conclusion: The use of vascular impedance and color Doppler of the uterine artery and endometrial spiral arteries improves the diagnostic accuracy of TVS for the prediction of endometrial diseases. It makes screening for malignant and premalignant lesions easier.
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