Prioritizing lean management practices in public and private hospitals.

Purpose - The purpose of this paper is to prioritize 21 healthcare wastes in public and private hospitals of United Arab Emirates (UAE). Design/methodology/approach - Seven healthcare wastes linked with lean management are further decomposed in to sub-criteria and to deal with this complexity of multi criteria decision-making process, analytical hierarchical process (AHP) method is used in this research. Findings - AHP framework for this study resulted in a ranking of 21 healthcare wastes in public and private hospitals of UAE.

Extracorporeal photopheresis for chronic graft-versus-host disease: a systematic review and meta-analysis.

Background: The safety of extracorporeal photopheresis (ECP) in steroid-refractory chronic graft-versus-host disease (SR-cGVHD) has been explored in multiple studies but reported response rates (RR) vary significantly across studies.

Methods: We conducted a meta-analysis to assess the efficacy of ECP for SR-cGVHD. A search of electronic databases for studies published between 1984 and 2012 was conducted.

Early-onset cerebellar atrophy associated with mutation in the CACNA1A gene.

Mutations in the CACNA1A gene were described in familial hemiplegic migraine, episodic ataxia type 2, and spinocerebellar ataxia type 6. Familial hemiplegic migraine and episodic ataxia type 2 are caused by point mutations in the CACNA1A gene, and spinocerebellar ataxia type 6 develops as a result of a CAG triple expansion in exon 1 of the gene. Phenotypic variability and clinical overlap are well recognized.

Dermatologic conditions seen in end-stage renal disease.

The skin changes reported in patients with end-stage renal disease (ESRD) are diverse and manifold. In this article we focus on a collection of specific cutaneous entities seen most frequently in the setting of ESRD, each presenting with distinctive and unique morphology. These include perforating disorders, porphyria cutanea tarda, pseudoporphyria, calcinosis cutis, calciphylaxis, and nephrogenic systemic fibrosis.

Characteristics of Mohs practices in the United States: a recall survey of ACMS surgeons.

Objective: The purpose of this study is to better characterize the typical Mohs practice in the United States and to generate data that may be useful in future practice models.

Methods: A survey was mailed in 2004 to all 599 members of the American College of Mohs Surgery with United States addresses listed in the 2003 directory.

Results: Most respondents were part of a single speciality group, in a suburban or urban setting, performed between 501-1,000 cases per year, and had been in practice from 0-5 years.

Mutations in RNF135, a gene within the NF1 microdeletion region, cause phenotypic abnormalities including overgrowth.

17q11 microdeletions that encompass NF1 cause 5%-10% of cases of neurofibromatosis type 1, and individuals with microdeletions are typically taller than individuals with intragenic NF1 mutations, suggesting that deletion of a neighboring gene might promote human growth. We identified mutations in RNF135, which is within the NF1 microdeletion region, in six families characterized by overgrowth, learning disability, dysmorphic features and variable additional features. These data identify RNF135 as causative of a new overgrowth syndrome and demonstrate that RNF135 haploinsufficiency contributes to the phenotype of NF1 microdeletion cases.

Concurrence of systemic lupus erythematosus and pemphigus: coincidence or correlation?

Background: Pemphigus and systemic lupus erythematosus (SLE) have previously been reported to coexist in the same patient. However, the relationship between the 2 diseases has not been elucidated.

Objective: This review was conducted to examine the relationship between pemphigus and SLE when they occur together in the same patient.

Sodium metabisulfite--a marker for cosmetic allergy?

A 45-year-old woman developed dermatitis of the face after she applied a cosmetic package comprising day and night creams. Patch tests were performed with the British Contact Dermatitis Society (BCDS) standard, bases + preservatives, and cosmetic series in addition to samples of both creams and the individual constituents. She had positive tests to both cosmetic creams, sodium sulfite from the manufacturer's samples (5% white soft paraffin (WSP)), and sodium metabisulfite (1% pet) in our bases + preservatives battery.

Relationship between cancer and oral pemphigoid patients with antibodies to alpha6-integrin.

Background: Mucous membrane pemphigoid is an autoimmune mucocutaneous blistering disease. A subset, known as anti-epiligrin cicatricial pemphigoid is associated with a high risk for malignancy. Oral pemphigoid (OP) is limited to the oral cavity.

Multicentric reticulohistiocytosis.

Multicentric reticulohistiocytosis is a rare granulomatous disease of unknown etiology, characterized by cutaneous nodules and destructive arthritis. Skin lesions can cause significant deformity, and approximately half of affected patients develop a severe disabling arthritis. The disease is often associated with malignancy; however, the paraneoplastic nature of multicentric reticulohistiocytosis is not established.

Dual diagnosis of pemphigus vulgaris and connective tissue disease.

This is a retrospective analysis of patients with pemphigus vulgaris and connective tissue disease (CTD) present as systemic lupus erythematosus, mixed CTD, or both. Pemphigus vulgaris was severe, difficult to treat, but eventually responded to therapy, resulting in a remission. In 6 patients, the CTD was stable and controlled with symptomatic therapy, and in 7 patients required systemic therapy.

The use of mole-mapping diagrams to increase skin self-examination accuracy.

Background: Monthly skin self-examination (SSE) is associated with reduced incidence of advanced melanoma, but SSE is prone to error in detecting early changes of melanoma.

Objective: We sought to improve SSE accuracy by requiring participants to complete a mole-mapping diagram.

Methods: After completing a baseline survey, participants received SSE instruction, had their backs digitally photographed, and half were randomized to complete a mole-mapping diagram.

Anal involvement in pemphigus vulgaris.

Introduction: Anal involvement in patients with pemphigus vulgaris has rarely been reported. We report 16 pemphigus vulgaris patients with anal involvement.

Methods: We retrospectively reviewed the clinical data on 16 patients treated at a tertiary dermatology referral center.

Incidence of and risk factors for medical malpractice lawsuits among Mohs surgeons.

Background: Despite rising medical malpractice costs, little is known about the factors associated with claims filed against Mohs surgeons.

Objective: We sought to define the scope of medical malpractice claims filed against Mohs surgeons and to identify salient factors associated with the filing and disposition of those claims.

Methods: A comprehensive survey was mailed to 599 physicians with US addresses listed in the 2003 directory of the American College of Mohs Micrographic Surgery and Cutaneous Oncology.

Proliferating multicentric reticulohistiocytosis associated with papillary serous carcinoma of the endometrium.

Multicentric reticulohistiocytosis (MRH) is a rare histocytic disease characterized by destructive arthritis in association with classic skin findings. Although MRH is not strictly a paraneoplastic disease, one quarter of cases are malignancy related. We report a case of MRH with an initial remission followed by an acute exacerbation several years later heralding the clinical presentation of endometrial carcinoma.

Involvement of the female genital tract in pemphigus vulgaris.

Background: Involvement of the genital tract in women with pemphigus vulgaris has rarely been reported. We report 34 patients with pemphigus vulgaris who have involvement of the vulva, vagina, or both.

Methods: We reviewed the clinical data on 34 women treated at a tertiary dermatology referral center from July 1988 to June 2005.

Atrophic dermatofibrosarcoma protuberans: an uncommon and misleading variant.

A 23-year-old man presented with an atrophic lesion on his left anterior shoulder that had been present for at least 10 years. A previous biopsy had suggested a fibrohistiocytic origin; however, clinically it resembled morphoea or atrophoderma, and the lesion was observed. Fifteen months later, the lesion was noted to have grown slightly.