A healthy 35-year-old Brazilian woman presented with persistent redness, swelling, and multiple wounds on the hand 2 weeks after a cat bite in her home country. She was treated twice with amoxicillin-clavulanate but failed to demonstrate improvement. She then presented to our institution with a newly developed abscess on the right hand. Incision and drainage were performed and she was admitted to the hospital. She was subsequently treated with broad-spectrum antibiotics. Her symptoms improved but did not resolve. Four days after hospital discharge, a wound culture resulted as positive for Sporothrix schenchii. The patient was treated with itraconazole. Sporotrichosis is endemic in many countries including Brazil and is known to be transmitted by cat bites. Sporotrichosis should be considered in the differential diagnosis for patients who have symptoms of cellulitis after cat bites in an endemic area.
ObjectiveOsteoarthritis (OA) and pain are both made more severe by low‐grade inflammation. This study was undertaken to examine whether visceral fat, a major source of inflammatory cytokines and adipokines, is associated with an increased risk of knee OA or musculoskeletal pain.MethodsSubjects in the Multicenter Osteoarthritis Study cohort, who were age 50–79 years and had or were at high risk of knee OA, underwent whole‐body dual x‐ray absorptiometry (DXA) at baseline. At baseline, 30 months, and 60 months radiographs and magnetic resonance images (MRIs) of the knees were obtained, and patients were asked to score the severity of their knee pain and to identify sites of joint pain using a body homunculus. Baseline DXA scans were used to measure total body fat and visceral and subcutaneous fat in the torso. The association of fat depot size with structural outcomes (incident radiographic OA and cartilage loss and synovitis on MRI) and with pain outcomes (worsening knee pain, number of painful joints, and widespread pain) was assessed. Regression analyses were adjusted for age, sex, race, education level, smoking status, physical activity, body mass index (BMI), and depressive symptoms.ResultsOf the 2,961 participants at baseline, 60.7% were women. The mean age was 62.5 years and mean BMI was 30.5 kg/m2. After adjustment for covariates, no fat measures were associated with any structural outcomes. However, total and visceral, but not subcutaneous, fat were positively associated with worsening knee pain (P = 0.0005 for total fat and P = 0.007 for visceral fat) and widespread pain (P = 0.001 for total fat and P = 0.02 for visceral fat), and the amount of visceral fat was associated with the number of painful joints (P = 0.07).ConclusionOur findings indicate that visceral fat is associated with an increased risk of musculoskeletal and widespread pain.
Background:Recent studies suggest that patients with lupus have higher rates of cervical dysplasia and pre-malignant lesions. We have a large population of lupus patients at our institution that may be at increased risk of dysplastic lesions due to suboptimal rates of HPV vaccination and cervical cancer screening. The aim of this study was to determine the rate of HPV vaccination completion and cervical cancer screening compliance among the lupus patients seen in our institution. In addition, we developed a process to increase patient education and improve both HPV and cervical cancer screening rates at the level of the outpatient renal, dermatology and rheumatology clinics.Objectives:To improve rates of cervical cancer screening and HPV vaccination among patients with LupusMethods:A comprehensive list was compiled of all patients with a diagnosis of lupus seen in the clinics over a 3 year period. A chart review of 332 patients was subsequently performed to determine the rate of HPV vaccination completion and the rate of compliance with cervical cancer screening. Methods were developed to improve these rates by streamlining access to HPV vaccination sites or facilitating referral for screening exams. Patients were also provided education through brochures about their increased risk.Results:Our results revealed that rates of HPV vaccination among lupus patients at our institution were lower than national averages by 11%. Rates of cervical cancer screening were also 21% lower compared to national average for this group of patients. In creating a system to flag providers and increase patient education, we were able to improve these rates. In the first two months, 73.7% of all patients seen in the clinics were provided education and 61.5% of eligible patients that were seen in clinic were appropriately referred to either their PCP or to gynecology to complete cervical cancer screening and prevention.Conclusion:Initial review of the lupus population at our institution highlighted a strong need to develop an intervention to improve vaccination and screening compliance in this population. By raising awareness amongst providers, we were able to significantly increase the number of at risk patients referred for cervical cancer screening and prevention. Given that the United States Food and Drug Administration has recently approved to expand the use of the HPV vaccine to women and men up to age 45, future efforts will be made to expand our eligble population to reflect these recommendations.References[1] “FDA Approves Expanded Use of Gardasil 9 to Include Individuals 27 through 45 Years Old.” FDA News Release, 5 Oct. 2018, www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm622715.htm.[2] “Gynecologic Cancers.” Centers for Disease Control and Prevention, 27 June 2018, www.cdc.gov/cancer/cervical/basic_info/test-results.htm.[3] “Practice Bulletin No. 140.” Obstetrics & Gynecology, vol. 122, no. 6, 2013, pp. 1338–1366., doi:10.1097/01.aog.0000438960.31355.9e.[4] “Vaccines & Immunizations.” Centers for Disease Control and Pr...
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