Vidhi V. Shah

Loss of Spatial Memory, Learning, and Motor Function During Normal Aging Is Accompanied by Changes in Brain Presenilin 1 and 2 Expression Levels

Mutations in presenilin (PS) proteins cause familial Alzheimer’s disease. We herein tested the hypothesis that the expression levels of PS proteins are differentially affected during healthy aging, in the absence of pathological mutations. We used a preclinical model for aging to identify associations between PS expression and quantitative behavioral parameters for spatial memory and learning and motor function. We identified significant changes of PS protein expression in both cerebellum and forebrain that correlated with the performance in behavioral paradigms for motor function and memory and learning. Overall, PS1 levels were decreased, while PS2 levels were increased in aged mice compared with young controls. Our study presents novel evidence for the differential expression of PS proteins in a nongenetic model for aging, resulting in an overall increase of the PS2 to PS1 ratio. Our findings provide a novel mechanistic basis for molecular and functional changes during normal aging.

Apremilast for a psoriasis patient with HIV and hepatitis C

densely packed, small round blue cells (Fig. 2b), arranged in irregular nests, immunoreactive with chromogranin and Keratin 20, thus consistent with MCC. Red nodules do represent diagnostic challenges for two reasons: first, they do not display specific clinical dermoscopic criteria that allow to correctly classify a given tumour; second, nodular tumours, especially high-grade tumours (i.e. melanoma and MCC), have a fast growing attitude and thus, a prompt excision could result in better prognosis. RCM is a relatively new device that is nowadays available in tertiary referral centres in Europe and in other countries. The great opportunity to observe cellular details in vivo makes RCM useful tools for tumour diagnosis. In the present case, we reported for the first time the typical RCM findings seen in MCC. Small hyoporefrective cells arranged to form solid aggregates are seen in the context of fibrotic stroma and prominent vasculature. Although those findings could be observed in some melanoma subtype (i.e. nevoid), the monomorphous appearance favoured the diagnosis of a non-melanoma skin cancer, not basal cell carcinoma. Interestingly, RCM findings mirrored perfectly the histopathologic aspects of MCC as displayed in Fig. 2. Although our description is based on one single case report, RCM could be of help in the differential diagnosis of red nodules and in the identification of MCC. Further multicentric studies on this rare tumour are warranted to further explore RCM-specific morphology and the value of MCC confocal features in clinical practice.

Vascular Features of Nail Psoriasis Using Dynamic Optical Coherence Tomography

Background: Nail psoriasis is a painful and disfiguring nail disease that often leads to invasive biopsies. Dermoscopy of the hyponychium can be useful in the diagnosis showing twisted coiled vessels. Structural features of nail psoriasis have been described with optical coherence tomography (OCT). Objectives: To investigate vascular features of nail psoriasis using dynamic OCT. Methods: This was an observational, prospective, controlled study in which psoriasis patients with psoriatic nail changes and healthy control patients underwent OCT imaging of the distal nail plate and proximal nail fold. Vertical and horizontal OCT images were analyzed to describe structural and vascular features and to quantify blood flow at depth. Results: Sixteen psoriatic nails and 16 control nails were included. Psoriatic nails had significantly increased blood flow in the proximal nail fold at depths of 0.72 mm (p = 0.035) and 0.76 mm (p = 0.027). Nail thickness was significantly greater in psoriatic nails compared to control nails (p = 0.0016). Compared to control nails, psoriatic nails had dilated, disorganized blood vessels superficially in the proximal nail fold. Limitations: The main limitation of our study is the relatively small sample size. Conclusions: OCT can identify structural and vascular features specific to nail psoriasis.

Comparison of guidelines for the use of TNF inhibitors for psoriasis in the United States, Canada, Europe and the United Kingdom: a critical appraisal and comprehensive review

Abstract Purpose: To compare and contrast evidence-based CPGs from leading dermatological organizations for the use of tumor necrosis factor inhibitors (TNFi) in psoriasis. Materials and methods: Guidelines from the British National Institute for Health and Care Excellence (NICE), the British Association of Dermatologists (BAD), the American Academy of Dermatology (AAD), the National Psoriasis Foundation (NPF), and the Canadian Dermatology Association (CDA) were reviewed and compared. Results: Various guidelines are similar regarding treatment initiation but have significant differences regarding topics such as continuous versus intermittent therapy, use in erythrodermic and pustular palmoplantar psoriasis and special patient populations. Conclusion: TNF inhibitors remain valuable tools in psoriasis therapy, and guidelines for their use may help clinicians use them effectively.

Medical Malpractice in Dermatology-Part I: Reducing the Risks of a Lawsuit.

Malpractice risk is a common source of concern for the practicing physician. Dermatologists experience fewer lawsuits than most other specialists in medicine, but the risk is not negligible. All physicians should familiarize themselves with areas of potential risk and avoid medico-legal pitfalls. We present Part I of a two-part series addressing medico-legal questions common to most practitioners that cause a great deal of anxiety. Part I will focus upon risk management and prevention of future malpractice lawsuits, and Part II deals with suggestions and guidance once a lawsuit occurs. Herein, we discuss the primary sources of malpractice lawsuits delivered against healthcare practitioners including issues with informed consent, patient noncompliance, medical negligence, and inappropriate documentation, including use of electronic medical records. The overall goal is to effectively avoid these common sources of litigation. The risk management strategies discussed in this paper are relevant to the everyday practitioner and may offer physicians some degree of protection from potential liability.