Objectives Hip fractures are common, morbid, and costly health events that threaten the independence and function of older patients. The purpose of this systematic review and meta-analysis was to determine if ortho-geriatric collaboration models improve outcomes. Data Sources Articles in English and Spanish languages were searched in electronic databases including MEDLINE, CINAHL, EMBASE, and the Cochrane Registry from 1992 to 2012. Study Selection Studies were included if they described an inpatient multidisciplinary approach to hip fracture management involving an orthopedic surgeon and a geriatrician. Studies were grouped into three categories: routine geriatric consultation, geriatric ward with orthopedic consultation, and shared care. After independent review of 1,480 citations by two authors, 18 studies (9,094 patients) were identified as meeting the inclusion criteria. Data Extraction In-hospital mortality, length of stay, and long-term mortality outcomes were collected. Data Synthesis A random effects model meta-analysis determined whether the ortho-geriatric collaboration was associated with improved outcomes. The overall meta-analysis found ortho-geriatric collaboration was associated with a significant reduction of in-hospital mortality (RR 0.60, 95%CI 0.43, 0.84) and long-term mortality (RR 0.83, 95%CI 0.74, 0.94). Length of stay (SMD −0.25, 95%CI −0.44, −0.05) was significantly reduced, particularly in the shared care model (SMD −0.61, 95%CI −0.95, −0.28), but heterogeneity limited this interpretation. Other variables such as time to surgery, delirium, and functional status were measured infrequently. Conclusions This meta-analysis supports ortho-geriatric collaboration to improve mortality after hip repair. Further study is needed to determine the best model of ortho-geriatric collaboration, and if these partnerships improve functional outcomes.

Background Tinea capitis is a common pediatric dermatophyte infection. Its main pathogen in the United States is Trichophyton tonsurans accounting for greater than 95% of the infections. Other pathogens including Trichophyton violaceum and Trichophyton soudanense are common in Africa. Although rare in the United States, their prevalence is increasing, possibly because of immigration patterns. We evaluated the demographic characteristics, treatments, and resolution among pediatric patients with T. violaceum and T. soudanense infections. Methods Retrospective chart review of patients from Mayo Clinic in Rochester, Minnesota, United States, with cultures positive for T. violaceum and T. soudanense from 1997 to 2014. Age at presentation, ethnic background, date and location of culture, and treatment were extracted. Results In total, 81 children (age <18 years) were identified as positive for T. violaceum and T. soudanense (mean [range] age, 6.0 [1-17] years). Race/ethnicity of 67 patients (82.7%) was African; four, African-American; three, white; two, Asian; and five, unknown. After culture identification, 64 patients (79.0%) received griseofulvin; five, terbinafine; and three, itraconazole; nine patients had no documented oral antifungal therapy. Of 28 patients not lost to follow-up, median time to clinical cure was 2.3 months (interquartile range, 2.8 months).

Sebaceous carcinomas (SC) are rare adnexal tumors with possible aggressive behavior usually arising in the head and neck region of adults in the seventh decade of life. Treatment has traditionally been with surgical excision with 5-6 mm wide margins but Mohs micrographic surgery (MMS) has also been reported as an effective treatment modality. We present a case of a Caucasian female renal transplant patient with a rapidly enlarging nodule on the left preauricular cheek that was excised with MMS with negative margins. The tumor recurred rapidly and metastasized ultimately leading to the death of the patient. There was some disagreement amongst pathologists as to the possible nature of the diagnosis with the original biopsy being labeled as a poorly differentiated carcinoma. We aim to highlight the potential aggressive nature of SC and review the features of the neoplasm including histological features that help in making the diagnosis.

IMPORTANCE Allogeneic hematopoietic cell transplant (alloHCT) is known to increase the risk for keratinocyte carcinoma. The extent to which host characteristics, including pigmentary phenotype and UV radiation exposure, contribute is unknown.OBJECTIVE To identify and validate independent risk factors for keratinocyte carcinoma after alloHCT, including those associated with the transplant and the host.

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