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Veteranos , Humanos , Veteranos/estadística & datos numéricos , Masculino , Estados Unidos , Persona de Mediana Edad , Femenino , Hospitales de Veteranos/estadística & datos numéricos , United States Department of Veterans Affairs/estadística & datos numéricos , United States Department of Veterans Affairs/organización & administración , Examen Físico/métodos , Examen Físico/normas , Examen Físico/estadística & datos numéricos , Cooperación del Paciente/estadística & datos numéricos , Anciano , PielRESUMEN
This case report describes a patient with Trichophyton mentagrophytes internal transcribed spacer genotype VII resulting in tinea genitalis, glutealis, and corporis.
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Tiña , Humanos , Tiña/transmisión , Tiña/diagnóstico , Tiña/microbiología , Femenino , Masculino , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/transmisión , Enfermedades de Transmisión Sexual/microbiología , AdultoRESUMEN
Importance: Trichophyton indotineae is an emerging dermatophyte causing outbreaks of extensive tinea infections often unresponsive to terbinafine. This species has been detected worldwide and in multiple US states, yet detailed US data on infections with T indotineae are sparse and could improve treatment practices and medical understanding of transmission. Objective: To correlate clinical features of T indotineae infections with in vitro antifungal susceptibility testing results, squalene epoxidase gene sequence variations, and isolate relatedness using whole-genome sequencing. Design, Setting, and Participants: This retrospective cohort study of patients with T indotineae infections in New York City spanned May 2022 to May 2023. Patients with confirmed T indotineae infections were recruited from 6 New York City medical centers. Main Outcome and Measure: Improvement or resolution at the last follow-up assessment. Results: Among 11 patients with T indotineae (6 male and 5 female patients; median [range] age, 39 [10-65] years), 2 were pregnant; 1 had lymphoma; and the remainder were immunocompetent. Nine patients reported previous travel to Bangladesh. All had widespread lesions with variable scale and inflammation, topical antifungal monotherapy failure, and diagnostic delays (range, 3-42 months). Terbinafine treatment failed in 7 patients at standard doses (250 mg daily) for prolonged duration; these patients also had isolates with amino acid substitutions at positions 393 (L393S) or 397 (F397L) in squalene epoxidase that correlated with elevated terbinafine minimum inhibitory concentrations of 0.5 µg/mL or higher. Patients who were treated with fluconazole and griseofulvin improved in 2 of 4 and 2 of 5 instances, respectively, without correlation between outcomes and antifungal minimum inhibitory concentrations. Furthermore, 5 of 7 patients treated with itraconazole cleared or had improvement at the last follow-up, and 2 of 7 were lost to follow-up or stopped treatment. Based on whole-genome sequencing analysis, US isolates formed a cluster distinct from Indian isolates. Conclusion and Relevance: The results of this case series suggest that disease severity, diagnostic delays, and lack of response to typically used doses and durations of antifungals for tinea were common in this primarily immunocompetent patient cohort with T indotineae, consistent with published data. Itraconazole was generally effective, and the acquisition of infection was likely in Bangladesh.
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Antifúngicos , Pruebas de Sensibilidad Microbiana , Tiña , Trichophyton , Humanos , Masculino , Femenino , Antifúngicos/farmacología , Antifúngicos/administración & dosificación , Persona de Mediana Edad , Estudios Retrospectivos , Tiña/tratamiento farmacológico , Tiña/microbiología , Tiña/diagnóstico , Adulto , Anciano , Trichophyton/efectos de los fármacos , Trichophyton/genética , Trichophyton/aislamiento & purificación , Adolescente , Niño , Adulto Joven , Secuenciación Completa del Genoma , Escualeno-Monooxigenasa/genética , Ciudad de Nueva York/epidemiología , Terbinafina/farmacología , Terbinafina/administración & dosificación , Farmacorresistencia Fúngica , Estudios de CohortesRESUMEN
BACKGROUND: In the United States (US), dermatology remains one of the least diverse specialties in medicine. Increasing the diversity of the dermatology workforce is essential for reducing health disparities. OBJECTIVE: To describe the experiences of racially and ethnically diverse physicians in the US who successfully matched into dermatology. METHODS: Board-certified dermatologists and dermatology residents were recruited to participate in an anonymous, online survey in which self-reported demographic, socioeconomic, pre-residency, and post-residency career data were obtained. RESULTS: Of the 100 participants included in the study, 30% were dermatology residents and 25% belonged to a group underrepresented in medicine (UIM). Black physicians were 3.69 times more likely to select dermatology prior to medical school (odds ratio [OR], 3.69; 95% confidence interval [CI], 1.04 - 13.0) compared to non-Black physicians. UIM dermatologists and trainees were more likely to receive a need-based scholarship in medical school (OR, 4.37; 95% CI, 1.30 - 14.7), graduate from a private medical institution (OR, 6.49; 95% CI, 1.95 - 21.6), and have at least one UIM dermatology mentor during medical school (adjusted OR, 13.1; 95% CI, 2.77 - 61.5) compared to non-UIM physicians. CONCLUSIONS: A holistic review of dermatology applicants by residency programs may reduce racial/ethnic disparities in the admission process. Our data provide further evidence in support of pre-medical outreach programs, mentorship, and institutional funding to promote diversity in dermatology.
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Dermatología , Internado y Residencia , Médicos , Dermatología/educación , Etnicidad , Humanos , Estados Unidos , Recursos HumanosRESUMEN
Introduction: Recent research on vitamin D has shown that the fat-soluble micronutrient has anti-microbial, anti-inflammatory, and anti-proliferative effects in cells and tissues. During wound healing, abnormal scarring may occur and lead to reduced mobility, disfigurement, and psychosocial concerns. The role of vitamin D in the pathogenesis and treatment of scarring has not been reviewed previously. Methods: A literature search was performed on PubMed to identify articles on vitamin D and keloid, hypertrophic, or burn scars. Results: Molecular, epidemiological, and human clinical studies are discussed. Overall, the evidence suggests lower levels of vitamin D precursors, the active metabolite, and receptor, are associated with increased risk of scar development and increased severity. Conclusions: Scars are challenging to treat, and patients are increasingly interested in non-invasive treatment options. Although few human clinical studies have been reported, vitamin D may be beneficial as an adjunct therapy to current treatment options. J Drugs Dermatol. 2020;19(7): doi:10.36849/JDD.2020.4986.
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Cicatriz/terapia , Deficiencia de Vitamina D/dietoterapia , Vitamina D/administración & dosificación , Vitaminas/administración & dosificación , Cicatrización de Heridas/fisiología , Cicatriz/diagnóstico , Cicatriz/etiología , Cicatriz/patología , Terapia Combinada/métodos , Fibroblastos/metabolismo , Fibroblastos/patología , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Receptores de Calcitriol/genética , Receptores de Calcitriol/metabolismo , Índice de Severidad de la Enfermedad , Piel/citología , Piel/patología , Resultado del Tratamiento , Vitamina D/sangre , Vitamina D/metabolismo , Deficiencia de Vitamina D/sangre , Deficiencia de Vitamina D/complicaciones , Deficiencia de Vitamina D/genética , Vitaminas/sangre , Vitaminas/metabolismo , Cicatrización de Heridas/efectos de los fármacosRESUMEN
Vitamin D is known to regulate innate and adaptive immune processes at the cellular level, but the role of vitamin D status on associated inflammatory processes across pregnancy is unclear. Our primary objective was to evaluate the relationships between serum biomarkers of inflammation (interleukin [IL]-6, IL-10, tumor necrosis factor [TNF]-α), acute-phase proteins (C-reactive protein and hepcidin) and vitamin D status, 25-hydroxyvitamin D (25(OH)D) and 1,25-dihydroxyvitamin D (1,25(OH)2D), measured across pregnancy and in the neonate at birth. A second objective was to identify associations between vitamin D status and clinically diagnosed infections. In this study, 158 racially and ethnically diverse pregnant adolescents were recruited from the Rochester Adolescent Maternity Program (RAMP) in Rochester, NY. Serum 1,25(OH)2D was significantly lower in adolescents and neonates with IL-6 concentrations above the 75th percentile at delivery ( P = .04) and at birth ( P = .004), respectively. After adjusting for other potential covariates of inflammation, maternal serum 1,25(OH)2D was significantly positively associated with TNF-α during pregnancy ( P = .02), but at delivery 1,25(OH)2D and TNF-α were inversely associated with one another ( P = .02). Teens with 25(OH)D concentrations <30 ng/mL were more likely to test positive for candida ( P = .002) and bacterial vaginosis ( P = .02) during pregnancy. African Americans exhibited significantly lower TNF-α concentrations at both mid-gestation ( P = .009) and delivery ( P = .001) compared to the Caucasian adolescents. These results suggest that lower maternal vitamin D status may increase risk of infection across gestation.
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Citocinas/sangre , Inflamación/sangre , Infecciones Estreptocócicas/sangre , Vaginosis Bacteriana/sangre , Vitamina D/análogos & derivados , Adolescente , Biomarcadores/sangre , Femenino , Humanos , Embarazo , Vitamina D/sangreRESUMEN
Vitamin D is thought to modulate innate immune responses, and recent studies have highlighted the autocrine and paracrine functions of vitamin D in the placenta. Our objective was to determine the relationship between maternal vitamin D status and placental antimicrobial peptide (AMP) expression in a group of racially and ethnically diverse pregnant adolescents. In this study, 158 pregnant adolescents were recruited from the Rochester Adolescent Maternity Program (RAMP) in Rochester, NY. Maternal serum concentrations of the vitamin D biomarkers, 25-hydroxyvitamin D (25(OH)D) and 1,25-dihydroxyvitamin D (1,25(OH)2D), were measured at mid-gestation (â¼26 weeks) and at delivery. At the placental level, vitamin D regulatory proteins (cubilin, megalin, 1α-hydroxylase (CYP27B1), 24-hydroxylase (CYP24A1), vitamin D receptor (VDR)) and AMPs (cathelicidin and hepcidin) were analyzed using quantitative PCR and western blot techniques. Placental CYP27B1 mRNA expression was significantly positively associated with both placental cathelicidin mRNA expression (P<0.0001) and placental hepcidin mRNA expression (P=0.002). In teens with positive recto-vaginal group B streptococcus (GBS) colonization, placental mRNA expression of cathelicidin (P=0.007), cubilin (P=0.03), and CYP27B1 (P=0.04) were significantly lower compared to those who tested negative for this infection. A mediation analysis showed that the indirect relationship between GBS colonization and placental cathelicidin mRNA expression was mediated by the placental mRNA expression of the vitamin D proteins cubilin and CYP27B1 (P=0.02). Additional research is needed to identify the role and relative contributions of placental and systemic vitamin D metabolites in relation to potentially pathogenic microorganisms which may be present during pregnancy.
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25-Hidroxivitamina D3 1-alfa-Hidroxilasa/metabolismo , Péptidos Catiónicos Antimicrobianos/metabolismo , Placenta/metabolismo , Receptores de Superficie Celular/metabolismo , Recto/microbiología , Infecciones Estreptocócicas/inmunología , Streptococcus agalactiae/inmunología , Vagina/inmunología , Vitamina D/metabolismo , 25-Hidroxivitamina D3 1-alfa-Hidroxilasa/genética , Adolescente , Adulto , Péptidos Catiónicos Antimicrobianos/genética , Femenino , Regulación Bacteriana de la Expresión Génica , Interacciones Huésped-Patógeno , Humanos , Exposición Materna , Embarazo , Embarazo de Alto Riesgo , ARN Mensajero/análisis , Receptores de Superficie Celular/genética , Vagina/microbiología , Adulto Joven , CatelicidinasRESUMEN
STUDY OBJECTIVE: Our objective was to identify risk factors associated with maternal infections and placental inflammation in pregnant adolescents attending an urban adolescent maternity clinic. DESIGN: This cross-sectional, descriptive study used survey and medical chart data collected at entry and prospectively across gestation. The prevalence of maternal infections and placental inflammation was determined and potential risk factors were identified. SETTING: Rochester Adolescent Maternal Program (RAMP) in Rochester, NY. PARTICIPANTS: Racially and ethnically diverse pregnant adolescents (n = 158 ≤ 18 y at entry) were recruited. INTERVENTIONS AND MAIN OUTCOME MEASURES: Main outcome measures were diagnosis of an infection or inflammatory condition in relation to demographic, anthropometric, dietary, socioeconomic, and health data. RESULTS: The three most prevalent infections diagnosed in this study population were recto-vaginal colonization of group B Streptococcus (GBS) (38%), bacterial vaginosis (BV) (40%) and candida (42%). African-American teens (AOR = 4.6; 95% CI: 1.74-13.02) and those with higher pre-pregnancy BMI (ppBMI; AOR = 1.2; 95% CI: 1.04-1.31) were more likely to test positive for BV across gestation. Older maternal age decreased the likelihood of positive tests for trichomoniasis (OR = 0.51; 95% CI: 0.26-0.92) and gonorrhea (OR = 0.38; 95% CI: 0.16-0.82). Higher mean dietary vitamin D intake (mcg/d) was associated with a lower likelihood of testing positive for recto-vaginal GBS (OR = 0.87; 95% CI: 0.77-0.98). CONCLUSION: Addressing modifiable risk factors associated with dietary intake and pre-pregnancy weight may help reduce health disparities among pregnant minority adolescents. Additionally, targeted sexual health education may greatly benefit younger female adolescents.
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Negro o Afroamericano/estadística & datos numéricos , Hispánicos o Latinos/estadística & datos numéricos , Complicaciones Infecciosas del Embarazo/epidemiología , Adolescente , Factores de Edad , Índice de Masa Corporal , Candidiasis Vulvovaginal/epidemiología , Candidiasis Vulvovaginal/etiología , Estudios Transversales , Femenino , Gonorrea/epidemiología , Gonorrea/etiología , Disparidades en el Estado de Salud , Humanos , Embarazo , Complicaciones Infecciosas del Embarazo/etiología , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Infecciones Estreptocócicas/epidemiología , Infecciones Estreptocócicas/etiología , Streptococcus agalactiae , Vaginitis por Trichomonas/epidemiología , Vaginitis por Trichomonas/etiología , Servicios Urbanos de Salud/estadística & datos numéricos , Vaginosis Bacteriana/epidemiología , Vaginosis Bacteriana/etiologíaRESUMEN
BACKGROUND: Few data exist on the ability of postmenopausal women to absorb calcium from diets habitually low in calcium. OBJECTIVE: The objective of this study was to evaluate fractional calcium absorption from a green leafy vegetable vs. milk in relation to vitamin D status. METHODS: We measured fractional calcium absorption from both a dairy- and plant-based source in 19 postmenopausal Thai women (aged 52-63 y) with low calcium consumption (350 ± 207 mg/d) in relation to serum parathyroid hormone (PTH) and serum 25-hydroxyvitamin D [25(OH)D]. Fractional calcium absorption was measured using a triple stable calcium isotope method based on isotope recovery in a 28-h urine collection. Two extrinsically labeled test meals were ingested in random order: a green leafy vegetable (cassia) ingested along with 4³Ca or a glass of milk containing 44Ca. Women received intravenous 4²Ca with the first test meal. RESULTS: In 19 postmenopausal women studied (mean age, 56.9 ± 3.4 y), ~95% were 25(OH)D sufficient (≥20 µg/L). Serum 25(OH)D status was positively correlated with fractional absorption from both cassia (P = 0.05, R² = 0.21) and milk (P = 0.03, R² = 0.26). Fractional calcium absorption from cassia was significantly lower than that measured from milk (42.6% ± 12.3% vs. 47.8% ± 12.8%, P = 0.03), but true calcium absorption did not significantly differ (120 ± 35 mg/d vs. 135 ± 36 mg/d). Serum PTH was significantly inversely associated with serum 25(OH)D (P = 0.006, R² = 0.37) even though PTH was not elevated (>65 pg/mL). CONCLUSIONS: These findings suggest that vitamin D status is an important determinant of calcium absorption among Thai women with low calcium intakes, and cassia may be a readily available source of calcium in this population. Furthermore, these data indicate that serum 25(OH)D concentrations may affect PTH elevation in postmenopausal women with low calcium intakes.