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Pain Terminology

from ArchPedi - 01 Dec 14

To the Editor I read with interest the Viewpoint recently published in JAMA Pediatrics expressing frustration with the term functional pain to describe the common scenario of chronic pain from unidentified causes. However, I question the author’s recommendation to change the name to primary pain disorder. Just because the cause of a symptom is unknown does not mean that it has no cause; absence of proof is not proof of absence. Diagnostic delay is common in complex illnesses and not all patients



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Pain Terminology

from ArchPedi - 01 Dec 14

To the Editor I concur with Dr Schechter’s appeal recently published in JAMA Pediatrics to discontinue the use of the term functional pain but find his proposed new term, primary pain disorder, equally unsatisfying. It is akin to telling someone with a fast heart rate they have tachycardia. Although he dismisses the term amplified pain, interpreted by patients as implying they are amplifying or exaggerating their pain, it is not so interpreted by my patients. Strumming a guitar string is a rathe



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Pain Terminology—Reply

from ArchPedi - 01 Dec 14

In Reply I appreciate the responses of Drs Oaklander and Sherry. Both of them agree with me in abandoning the term functional pain, which I perceive to be inappropriately burdened by the mantle of psychogenesis. Although they both disagree with the term that I have proposed as an alternative, primary pain disorders, they state opposing grounds for their objections. Dr Oaklander suggests the term implies too much, intimating an understanding of these entities that may be premature, and offers med



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Surgery and Neurodevelopmental Impairment Need for Time-Dependent Covariates to Correct for Confounding by Indication

from ArchPedi - 01 Dec 14

To the Editor We read with interest the study by Morriss et al and the accompanying editorial recently published in JAMA Pediatrics. We applaud their use of a propensity score modeling approach to answer the following question facing neonatologists and surgeons: is it the surgery or the underlying condition/status of the infant that is associated with neurodevelopmental impairment? However, we wish to highlight an important shortcoming in the authors’ attempt to reduce bias owing to confounding



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Surgery and Neurodevelopmental Impairment—Reply

from ArchPedi - 01 Dec 14

In Reply We appreciate the careful reading of our article by Weisz et al recently published in JAMA Pediatrics, who point out that our propensity score calculations omit consideration of the timing of surgery, an important variable in adjusting for selection bias. While we have dates of occurrence for some of the morbidities that we adjusted for, the Neonatal Research Network Generic Database does not contain information on the timing of surgery for the birth years 1998 to 2009. Consequently, th



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Texting and Driving

from ArchPedi - 01 Dec 14

Adolescents are generally a healthy age group. The major cause of injury and death in this population is unintentional injury, particularly motor vehicle crashes. In recent years, texting has become a new behavior that has impacted teen driving.



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JAMA Pediatrics

from ArchPedi - 01 Dec 14

JAMA Pediatrics Vision: JAMA Pediatrics will be the most respected source of information for investigators, providers, and policy makers seeking the highest quality evidence to guide decision-making.




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Menopausal Hormone Replacement Therapy in Dermatology

from ArchDerm - 01 Dec 14

Dermatologists provide care for perimenopausal and menopausal women with hormone-related complaints: hair loss, acne climacterica, acne rosacea, acne inversa (hidradenitis suppurativa), dry skin, wrinkling, hirsutism, pruritus vulvae, and other vulvar dermatoses. The question, “Should I take hormone replacement therapy (HRT)?” is usually unspoken. The answer was complicated in 2002 by the estrogen-progestin arm of the Women’s Health Initiative (WHI) study with the reported increased risk of inva



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Hidradenitis Suppurativa Current Progress and Future Questions

from ArchDerm - 01 Dec 14

Hidradenitis suppurativa (HS) is a chronic, destructive, debilitating inflammatory skin disease characterized by recurrent, painful, deep-seated nodules and/or abscesses in intertriginous areas. It is also relatively common, with a reported prevalence as high as 1% to 4%. Nevertheless, HS has historically been an orphan disease, unclaimed by any specialty, owing, perhaps largely, to the treatment challenges it poses for physicians and the resulting nonadherence on the part of patients.



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Association of Metabolic Syndrome and Hidradenitis Suppurativa

from ArchDerm - 01 Dec 14

ImportanceAn association between the metabolic syndrome (MetS) and chronic inflammatory diseases, such as psoriasis or rheumatoid arthritis, has been suggested. Hidradenitis suppurativa (HS), a more localized chronic inflammation of the skin, has been speculated to have a similar association. Hidradenitis suppurativa is a substantial burden for the individual and a socioeconomic burden globally. Information about the burden of possible comorbidities is scarce.ObjectiveTo investigate the possibil



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Efficacy of Photodynamic Therapy vs Other Interventions in Randomized Clinical Trials for the Treatment of Actinic Keratoses A Systematic Review and Meta-analysis

from ArchDerm - 01 Dec 14

ImportancePhotodynamic therapy (PDT) is used extensively to treat actinic keratoses (AKs). An analysis of the effectiveness of PDT compared with other treatments may help physicians decide what role it should play in their own clinical practices.ObjectiveTo determine the effectiveness of PDT for the treatment of AKs relative to other methods.Data SourcesMEDLINE, EMBASE, Web of Knowledge, and Cochrane Central Register. No restrictions on years were placed, and all searches extended to the year of



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The Accuracy of Dermatology Network Physician Directories Posted by Medicare Advantage Health Plans in an Era of Narrow Networks

from ArchDerm - 01 Dec 14

ImportanceInsurers are increasingly deploying “narrow networks” with fewer contracted physicians both in health plans offered in new state exchanges under the Affordable Care Act and in Medicare Advantage (MA) plans, which are commercial alternatives offered to Medicare beneficiaries. Patients choosing health plans rely on the accuracy of network directories posted by insurers. The MA plans must meet network adequacy requirements, and inaccurate directories of participating physicians might prej



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Regional Variation of and Association of US Birthplace With Vitiligo Extent

from ArchDerm - 01 Dec 14

ImportanceLittle is known about population-based risk factors and regional differences for vitiligo.ObjectiveTo determine the impact of place of birth and residence on vitiligo extent.Design, Setting, and ParticipantsA prospective questionnaire-based study using an online questionnaire with 2786 adults (72.2% of whom resided in the United States) with a history of physician-diagnosed vitiligo.ExposuresRegions of birth and residence.Main Outcomes and MeasuresBody surface area (BSA) of vitiligo le



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Comparison of Clinicopathologic Features and Survival of Histopathologically Amelanotic and Pigmented Melanomas A Population-Based Study

from ArchDerm - 01 Dec 14

ImportancePrevious studies have reported that histopathologically amelanotic melanoma is associated with poorer survival than pigmented melanoma; however, small numbers of amelanotic melanomas, selected populations, lack of centralized pathologic review, or no adjustment for stage limit the interpretation or generalization of results from prior studies.ObjectiveTo compare melanoma-specific survival between patients with histopathologically amelanotic and those with pigmented melanoma in a large



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Screening for Germline Mismatch Repair Mutations Following Diagnosis of Sebaceous Neoplasm

from ArchDerm - 01 Dec 14

ImportanceSebaceous neoplasms (SNs) define the Muir-Torre syndrome variant of Lynch syndrome (LS), which is associated with increased risk for colon and other cancers necessitating earlier and more frequent screening to reduce morbidity and mortality. Immunohistochemical (IHC) staining for mismatch repair (MMR) proteins in SNs can be used to screen for LS, but data on subsequent germline genetic testing to confirm LS diagnosis are limited.ObjectiveTo characterize the utility of IHC screening of



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Isotretinoin Exposure and Risk of Inflammatory Bowel Disease

from ArchDerm - 01 Dec 14

ImportanceIsotretinoin is the standard treatment for refractory severe nodulocystic acne. A true association between prior isotretinoin use and development of inflammatory bowel disease (IBD) is uncertain. Addressing the reality of this association is important in decision making for both the clinician and the patient when isotretinoin treatment is indicated.ObjectiveTo assess the risk of IBD mainly in patients with acne with and without isotretinoin exposure.Design, Setting, and ParticipantsIn



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High Anti–Desmoglein 3 Antibody ELISA Index and Negative Indirect Immunofluorescence Result in a Patient With Pemphigus Vulgaris in Remission Evaluation of the Antibody Profile by Newly Developed Meth

from ArchDerm - 01 Dec 14

ImportancePemphigus vulgaris (PV) is a disease that features blistering of the skin and mucous membranes caused by autoantibodies directed against desmoglein 3 (Dsg3) and/or desmoglein 1 (Dsg1). Indirect immunofluorescence (IIF) and enzyme-linked immunosorbent assay (ELISA) are 2 methods that are widely used to measure Dsg3 or Dsg1 antibody titers in PV. Although the titers of these autoantibodies are generally correlated with disease activity, some patients with a high ELISA index do not have s



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Subcutaneous Veltuzumab, a Humanized Anti-CD20 Antibody, in the Treatment of Refractory Pemphigus Vulgaris

from ArchDerm - 01 Dec 14

ImportanceB-cell depletion with the anti-CD20 antibody rituximab is highly effective for pemphigus vulgaris (PV) treatment. However, most patients experience relapse, and intravenous rituximab infusions are expensive. Therefore, cost-effective anti-CD20 therapies are desirable.ObservationsA compassionate-use investigational new drug protocol was approved to administer veltuzumab, a second-generation humanized anti-CD20 antibody, to a patient with refractory PV. Veltuzumab was administered as two



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Novel Genetic Mutations in a Sporadic Port-Wine Stain

from ArchDerm - 01 Dec 14

ImportancePort-wine stains (PWSs) are common congenital cutaneous capillary malformations. A somatic GNAQ mutation was recently identified in patients with sporadic PWSs and Sturge-Weber syndrome. However, subsequent studies to confirm or extend this observation are lacking.ObservationsWe report a long-standing, unilateral facial PWS of a man in his early 70s confirmed by histopathological analysis. Staged surgical excision of the vascular malformation was performed, and genomic DNA was extracte



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Alopecia Universalis Successfully Treated With Adalimumab

from ArchDerm - 01 Dec 14

ImportanceAlopecia universalis is an uncommon form of alopecia areata (AA) involving hair loss over the entire scalp and body and is often difficult to treat. Tumor necrosis factor (TNF) inhibitors have been largely unsuccessful in treating AA and have been reported to induce or worsen AA in patients. We report herein a case of alopecia universalis successfully treated with adalimumab and discuss the possible mechanism.ObservationsA woman in her 30s with alopecia universalis, refractory to multi



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Characterization of S628N A Novel KIT Mutation Found in a Metastatic Melanoma

from ArchDerm - 01 Dec 14

ImportanceThe KIT receptor is mutated in approximately 15% of acral, mucosal, and chronic, sun-damaged melanomas. The status of KIT mutations is of interest because they usually are mutually exclusive with N-RAS and B-RAF mutations and because of the availability of KIT kinase inhibitors in the clinic. Some recurrent KIT mutations are well characterized; others are poorly described.ObservationsWe describe a novel KIT mutation in a patient with metastatic melanoma. The mutation, located in exon 1




 

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