Hidradenitis Suppurativa: Consequences of Microbiome Dysbiosis on Immune Dysregulation and Disease Severity

Hidradenitis suppurativa (HS) is a chronic inflammatory condition characterized by the formation of nodules, abscesses, and sinus tracts with tunnels that primarily involves the skin folds. HS affects approximately 1% of the population, but its pathogenesis is unclear. Dysbiosis of skin microbiome is a major cause of HS and alterations of microbiome composition and diversity can be seen in the skin of patients with HS. These disruptions may contribute to the immune dysfunction seen in HS. Understanding these alterations and their contributions to the pathogenesis of HS could help guide future treatment. In addition to dysbiosis promoting immune dysregulation, HS may promote dysbiosis via differences in expression of antimicrobial peptides (AMPs). In this review, we have discussed the role of skin and gut microbiome in manifestation of HS and the consequences of dysbiosis on the immune system.

Exploring Match Space: How Medical School and Specialty Characteristics Affect Residency Match Geography in the United States

PURPOSE

To explore how school and specialty characteristics impact the geographic match location of U.S. senior medical students.

METHOD

The authors collected student match data between 2018 and 2020 from U.S. MD-granting medical schools and calculated the distance between students' medical schools and residency training programs. They use the term "match space" to describe this distance. Match space was codified on a 5-point ordinal scale by where the student matched: 1 = home institution, 2 = home state, 3 = an adjacent state, 4 = the same or adjacent U.S. Census division (and not adjacent state), and 5 = skipped at least one U.S. Census division. Ordinal logistic regression correlated school and specialty characteristics with match space.

RESULTS

During the study period, 26,102 medical students, representing 66 medical schools from 28 states, matched in 23 specialties. Fifty-nine percent of students were from public institutions, and 27% of schools ranked in the top 40 of National Institutes of Health (NIH) research funding. The match space was higher for students graduating from private institutions (odds ratio [OR] 1.14; 95% confidence interval [CI], 1.06 to 1.22) and matching into more competitive specialties (OR 1.07; 95% CI, 1 to 1.14). The match space was lower for students graduating from top NIH-funded institutions (OR 0.89; 95% CI, 0.85 to 0.94) and from schools with a higher percentage of in-state matriculants (OR 0.75; 95% CI, 0.72 to 0.77).

CONCLUSIONS

School characteristics such as region, public/private designation, NIH funding, and percentage of in-state students were associated with residency match geography. Matching into more competitive specialties also showed a marginal increase in match distance. These findings suggest that a student's choice of specialty and medical school may impact subsequent geographic placement for residency training, which should be considered by students and residency programs alike.

Nail Manifestations in COVID-19: Insight into a Systemic Viral Disease

Nail manifestations are 1 of the several extrapulmonary findings associated with COVID-19 caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Nail changes, however, have been largely ignored and not yet summarized. This article is intended to increase awareness of nail manifestations of SARS-CoV-2, which occur weeks to months after acute infection and the periungual pernio-like changes may occur concomitantly with infection. An electronic search was carried out in PubMed (Medline), Science Direct, and Scopus databases. The following keywords and all of their possible combinations were used to identify studies: “SARS-CoV-2,” “COVID-19,” “Coronavirus,” “2019-ncov,” “nail,” and “nails.” Six case reports were included in this study. Manifestations identified included red half-moon sign, transverse orange nail lesions, Mees' lines, and Beau's lines. Though largely nonspecific, these findings can be recognized with the onset of symptom onset or as late as 16 weeks following the disease. Some of these findings are shared with other conditions associated with a proinflammatory state. Nail changes offer unique insight into the pathophysiologic basis for SARS-CoV-2 and they may serve as diagnostic clues.

Common Cutaneous Infections: Patient Presentation, Clinical Course, and Treatment Options

This evidence-based review highlights cutaneous infections of bacterial, viral, and fungal origin that are frequently encountered by clinicians in all fields of practice. With a focus on treatment options and management, the scope of this article is to serve as a reference for physicians, regardless of field of specialty, as they encounter these pathogens in clinical practice.

Hidradenitis suppurativa: pathogenesis, clinical presentation, epidemiology, and comorbid associations

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that is clinically defined by lesions ranging from painful, deep seated nodules to abscesses, draining sinus tracts, and ultimately, irreversible fibrotic scars. While the etiology remains unclear, a number of mechanisms ranging from genetics to aberrations of the immune system have been proposed. In addition, HS has a number of associations and may occur in conjunction with several diseases that span a host of medical specialties. The estimated prevalence ranges are from 1% to 4%; however, a large degree of under-reporting and misdiagnosis of this condition likely underestimates its true clinical significance. The debilitating consequences of missed diagnoses or improper management leads to severe pain and irreversible cutaneous manifestations (i.e., fistulae, sinus tracts, disfiguring scarring). HS has been found to significantly impair patients' quality of life to a greater degree when compared with other skin conditions. Early recognition and treatment are critical for a favorable prognosis, and diagnostic delays may be related to variable presentations within numerous comorbidities. Here we provide an in-depth, clinical-based review of HS, highlighting the clinical presentation, pathophysiology, grading systems, epidemiology, and comorbidities, in hopes of shedding light on an often misunderstood disease and ultimately moving closer to a more conclusive understanding of its various presentations and association.

Descemet Membrane Endothelial Keratoplasty and Bowman Layer Transplantation: An Anatomic Review and Historical Survey

For nearly a century, the definitive treatment of many corneal dystrophies and ectactic disorders was limited to penetrating keratoplasty, but over the past 2 decades, a surge of surgical innovation has propelled the treatment of many corneal diseases to more targeted approaches with significantly better visual outcomes. Anterior stromal diseases were first changed through endothelial-sparing techniques, such as deep anterior lamellar keratoplasty, but have more recently transitioned to stromal-sparing approaches. Ultraviolet corneal crosslinking strengthens the cornea and halts progression of keratoconus in >90% of cases. Intracorneal ring segment and corneal allogenic ring segment implantation offer methods to flatten ectatic corneas. However, Bowman layer transplantation - inlay and more recently onlay techniques - has shown promise for treating advanced keratoconus and preventing keratoplasty. The advent of endothelial keratoplasty radically changed the treatment of corneal endothelial dysfunction, and Descemet membrane endothelial keratoplasty specifically offers an average postoperative visual acuity of 20/25 (0.8) with only 8.8% of grafts requiring retransplantation in the first 5 years. Here, we review the rapid innovations for surgical treatment of corneal diseases, spanning from endothelial keratoplasty and endothelial regeneration to anterior lamellar keratoplasty and stromal augmentation, highlighting key steps which may be moving us closer to a "postkeratoplasty" world.