Generalized Pustular Psoriasis: A Review of the Pathophysiology, Clinical Manifestations, Diagnosis, and Treatment.

Generalized pustular psoriasis (GPP) is a rare severe variant of psoriasis that is characterized by the abrupt widespread onset of small pustules accompanied by systemic manifestations of inflammation. It can arise in patients with a history of psoriasis as well as in those without, sometimes due to medication initiation or withdrawal, pregnancy, or infection. Generalized pustular psoriasis is thought to be driven primarily by innate immunity and unrestrained IL-36 cytokine activity.

Lead Toxicity and Environmental Health Justice Stories in Black and White Woodcut Portraits.

Background: Omaha, Nebraska, has a lead-contaminated superfund site and substandard housing that pose risks for childhood lead exposure. Healthy Housing Omaha (formerly, Omaha Healthy Kids Alliance), an environmental health nonprofit, partnered with the fourth author, an artist, and a newspaper to raise awareness about lead poisoning by publishing portraits and stories of affected community members.

Methods: The authors analyzed an interview with the artist, photographs of portraits published in a local newspaper, and quotations from portrait sitters.

Obstructive Constipation in Two Patients With Severe Osteogenesis Imperfecta and Acetabular Protrusio.

Osteogenesis imperfecta (OI) is a rare genetic condition resulting in decreased bone density and bony deformity and a wide variety of extraskeletal manifestations. Acetabular protrusio and constipation are both commonly associated with OI. We present two cases of severe pelvic deformity resulting in mechanical colonic outlet obstruction, which were successfully treated with a colostomy.

Liability in the Time of Coronavirus: The Ethical Necessity of Expanding the Legal Protections Afforded to Healthcare Workers During the COVID-19 Pandemic.

Although discussions have begun regarding the ways in which healthcare providers and individuals in fields adjacent to healthcare might be exposed to legal sanctions involving COVID-19, the complete scope of the legal risks is still largely unknown. This essay explores how current laws in the United States fail to offer adequate protections: (1) to healthcare workers (HCW) practicing under significantly altered standards of care, and (2) to individuals involved in the allocation of scarce resource decision-making process. Using research on Second Victim Syndrome and Medical Malpractice Stress Syndrome, legal protections are presented to provide HCW a form of "moral buffering" to help prevent further traumatizing them for shouldering extraordinary burdens during the COVID-19 pandemic.

What's Eating You? Culex Mosquitoes and West Nile Virus.

West Nile virus (WNV) commonly presents cutaneously as a maculopapular rash on the trunk and extremities that most often appears around the time of defervescence and may serve as a positive prognostic indicator. Several laboratory tests can aid in diagnosis of WNV, including an IgM enzyme-linked immunosorbent assay (ELISA), but an antibody response may not be detectable for up to 8 days after symptom onset. Taking a comprehensive history in any patient presenting with a generalized maculopapular rash, fever, nonspecific symptoms, or neurologic changes can aid the astute dermatologist in promptly recognizing the possibility of WNV.

Harnessing the Endocannabinoid System: What It Means for the Anesthesia Provider.

The desire to limit narcotic use, coupled with a desire for efficacious pain relief with few side effects, has led researchers and providers alike to focus on the possibilities inherent in the exploitation of the endocannabinoid system. In particular, fatty acid amide hydrolase (FAAH) inhibitors and monoamine glycerol lipase (MAGL) inhibitors hold great potential to become some of the next new classifications of pharmaceuticals formulated for not only pain relief, but a host of other conditions as well. This course is designed to introduce the reader to the endocannabinoid system, its components and mechanism of action, and examine how its effects are currently employed in anesthesia.

A Unique Mode of Failure in the Noncontact Bridging Periprosthetic Plating System.

Although lateral locking plates are often a preferred and successful fixation construct for the treatment of periprosthetic proximal and distal femur fractures, specific complications and modes of failure have been associated and well-described with their use. We present two cases of implant failure in the Non-Contact Bridge Periprosthetic Plating System (Zimmer Biomet) in which a nonlocked screw fretted through the annular seating of the plate. One case demonstrates failure in the setting of a proximal femur periprosthetic fracture, whereas the other demonstrates failure in the setting of a distal femur periprosthetic fracture.

Baricitinib plus Remdesivir for Hospitalized Adults with Covid-19.

Background: Severe coronavirus disease 2019 (Covid-19) is associated with dysregulated inflammation. The effects of combination treatment with baricitinib, a Janus kinase inhibitor, plus remdesivir are not known.

Methods: We conducted a double-blind, randomized, placebo-controlled trial evaluating baricitinib plus remdesivir in hospitalized adults with Covid-19.

Dusk to Dawn: Evaluating the effect of a hospital-based youth violence prevention program on youths' perception of risk.

Background: Historically, youth violence prevention strategies used deterrence-based programming with limited success. We developed a youth violence prevention program, Dusk to Dawn (D2D), intended to improve youths' recognition of high-risk situations and teach new skills in conflict resolution. The aim of this study was to evaluate the effect of D2D on youths' perceptions of personal risk factors and high-risk situations.

Long-Acting Cabotegravir and Rilpivirine for Maintenance of HIV-1 Suppression.

Background: Simplified regimens for the treatment of human immunodeficiency virus type 1 (HIV-1) infection may increase patient satisfaction and facilitate adherence.

Methods: In this phase 3, open-label, multicenter, noninferiority trial involving patients who had had plasma HIV-1 RNA levels of less than 50 copies per milliliter for at least 6 months while taking standard oral antiretroviral therapy, we randomly assigned participants (1:1) to either continue their oral therapy or switch to monthly intramuscular injections of long-acting cabotegravir, an HIV-1 integrase strand-transfer inhibitor, and long-acting rilpivirine, a nonnucleoside reverse-transcriptase inhibitor. The primary end point was the percentage of participants with an HIV-1 RNA level of 50 copies per milliliter or higher at week 48, determined with the use of the Food and Drug Administration snapshot algorithm.

One Month of Rifapentine plus Isoniazid to Prevent HIV-Related Tuberculosis.

Background: Tuberculosis is the leading killer of patients with human immunodeficiency virus (HIV) infection. Preventive therapy is effective, but current regimens are limited by poor implementation and low completion rates.

Methods: We conducted a randomized, open-label, phase 3 noninferiority trial comparing the efficacy and safety of a 1-month regimen of daily rifapentine plus isoniazid (1-month group) with 9 months of isoniazid alone (9-month group) in HIV-infected patients who were living in areas of high tuberculosis prevalence or who had evidence of latent tuberculosis infection.

Value and Meaning of Faith Community Nursing: Client and Nurse Perspectives.

The literature that supports and describes faith community nursing (FCN) practice is extensive, but limited in describing the value and meaning of FCN to the community. A qualitative investigation of one FCN program led to emergence of five themes that illustrate the perceived importance of FCN to this community: tasks and services offered, nursing expertise, spirituality, familiarity, and community support. This exploration reveals the deeper value and meaning of FCN to the communities these nurses support.

The Thrombolytic Effect of Diagnostic Ultrasound-Induced Microbubble Cavitation in Acute Carotid Thromboembolism.

Background: Acute ischemic stroke is often due to thromboembolism forming over ruptured atherosclerotic plaque in the carotid artery (CA). The presence of intraluminal CA thrombus is associated with a high risk of thromboembolic cerebral ischemic events. The cavitation induced by diagnostic ultrasound high mechanical index (MI) impulses applied locally during a commercially available intravenous microbubble infusion has dissolved intravascular thrombi, especially when using longer pulse durations.

Cystic Cervicitis: A Case Report and Literature Review of Cystic Cervical Lesions.

We present a case of a 30-year-old woman who, while undergoing infertility evaluation, was found to have a large cystic cervical mass, shown to be cystic cervicitis on cervical cone biopsy. Differential diagnosis for benign cystic cervical lesions includes Nabothian cysts, tunnel cluster, endocervical hyperplasia, and cervicitis, whereas cystic cervical malignancies include adenocarcinoma and adenoma malignum. While it is crucial to differentiate benign from malignant lesions, imaging characteristics often overlap and may not provide a specific diagnosis.

Regulation of Connexin43 Function and Expression by Tyrosine Kinase 2.

Connexin43 (Cx43) assembly and degradation, the regulation of electrical and metabolic coupling, as well as modulating the interaction with other proteins, involve phosphorylation. Here, we identified and characterized the biological significance of a novel tyrosine kinase that phosphorylates Cx43, tyrosine kinase 2 (Tyk2). Activation of Tyk2 led to a decrease in Cx43 gap junction communication by increasing the turnover rate of Cx43 from the plasma membrane.

Structural Studies of the Nedd4 WW Domains and Their Selectivity for the Connexin43 (Cx43) Carboxyl Terminus.

Neuronal precursor cell-expressed developmentally down-regulated 4 (Nedd4) was the first ubiquitin protein ligase identified to interact with connexin43 (Cx43), and its suppressed expression results in accumulation of gap junction plaques at the plasma membrane. Nedd4-mediated ubiquitination of Cx43 is required to recruit Eps15 and target Cx43 to the endocytic pathway. Although the Cx43 residues that undergo ubiquitination are still unknown, in this study we address other unresolved questions pertaining to the molecular mechanisms mediating the direct interaction between Nedd4 (WW1-3 domains) and Cx43 (carboxyl terminus (CT)).

Ipilimumab-induced hypophysitis and uveitis in a patient with metastatic melanoma and a history of ipilimumab-induced skin rash.

Ipilimumab, a monoclonal antibody that blocks cytotoxic T-lymphocyte-associated antigen-4, leading to enhanced T-cell activation and proliferation, is associated with improved overall survival in melanoma. Its use can result in immune-related adverse events, the most common of which are skin rash, diarrhea, and colitis. Ipilimumab-induced hypophysitis is uncommon, mostly involves anterior pituitary, and is associated with abnormalities in pituitary MRI, whereas uveitis has been rarely reported.

Risk Propensity and Safe Medication Administration.

Objective: To examine the relationship between risk propensity and safe medication administration, while also providing additional evidence of validity and reliability on the Safe Administration of Medication (SAM) Scale.

Methods: A convenience sample of nursing students from a private Midwest university in the United States was invited to participate in the study. Fourth-year nursing students completed 2 instruments: revised Domain-Specific Risk-Taking and Risk Perception (DOSPERT) Scale, which measures risk propensity, and the SAM Scale, which measures knowledge and performance of safe medication administration.

Serotonin Reuptake Inhibitors for the Treatment of Coexisting Depression and Psychosis in Dementia of the Alzheimer Type.

Four patients, ages 75 to 92 years, with a dementia of the Alzheimer type, presented with accompanying depression and psychosis. In these patients, treatment with a selective serotonin reuptake inhibitor resulted in a dramatic clearing of not only the depressive symptoms but the psychosis as well. Treatment was well tolerated in all cases.