How does Lichen Sclerosus et Atrophicus Present?
Discussion Lichen sclerosus et atrophicus (LSA) is a chronic inflammatory disease with a strong autoimmune association. It can occur with other autoimmune diseases. Its specific cause is unknown. It affects females and males of all ages, but especially females 40-60 years. In the pediatric population it affects prepubertal females most often. Treatment includes steroid medications or anti-inflammatory medications. Other treatments may be offered including phototherapy, and much less commonly systemic steroids or immunosuppressive therapy. Circumcision may also be an option for some males. Childhood LSA generally improves but can continue into adulthood. Scarring can occur with narrowing of the openings of the urethra, vagina, and anus and also the foreskin in males. Malignancy has been reported in adults but not children. The differential diagnosis includes post-inflammatory hypopigmentation, lichen planus, tinea versicolor, vitiligo or morphea (localized sclerosis). Malignancies should also be considered in older populations. Vulvovaginitis and sexual abuse should be considered in the differential diagnosis for children because of the genital irritation presentation but usually do not have the same physical examination appearance. Learning Point LSA lesions are shiny, and pale or white. The lesion edges can appear more diffuse or well-demarcated. The tissue appears shiny, thin, wrinkled and parchment-like, while others will describe it as a “porcelain white appearing c...
Decreased skeletal muscle strength and mitochondrial dysfunction are characteristic of diabetes. The actions of insulin and IGF-1 through the insulin receptor (IR) and IGF-1 receptor (IGF1R) maintain muscle mass via suppression of forkhead box O (FoxO) transcription factors, but whether FoxO activation coordinates atrophy in concert with mitochondrial dysfunction is unknown. We show that mitochondrial respiration and complex I activity were decreased in streptozotocin (STZ) diabetic muscle, but these defects were reversed in muscle-specific FoxO1, -3, and -4 triple-KO (M-FoxO TKO) mice rendered diabetic with STZ. In the ab...
CONCLUSION These findings reveal specific components of rest-activity rhythms associated with striatal D1R, D2/3R availability, and drug-rewarding effects. Personalized interventions that target rest-activity rhythms may help prevent and treat substance use disorders.TRIAL REGISTRATION ClinicalTrials.gov: NCT03190954.FUNDING National Institute on Alcohol Abuse and Alcoholism (ZIAAA000550).
Disrupted sleep and circadian rhythms are linked with substance abuse risk. Human studies that investigate relationships between sleep, circadian rhythm, and substance use reward generally rely on indirect means to infer dopaminergic function, such as functional magnetic resonance imaging. In this issue of the JCI, Zhang and colleagues used positron emission tomography (PET) to image striatal dopamine D1 (D1R) and D2/3 receptor (D/3R) availability in healthy adults. The authors assessed rest-activity rhythms, then conducted PET scans using radioligand antagonists selective for D1 receptors or D2/D3 receptors to measure D1R...
IL-1β is a proinflammatory mediator with roles in innate and adaptive immunity. Here we show that IL-1β contributes to autoimmune arthritis by inducing osteoclastogenic capacity in Tregs. Using mice with joint inflammation arising through deficiency of the IL-1 receptor antagonist (Il1rn–/–), we observed that IL-1β blockade attenuated disease more effectively in early arthritis than in established arthritis, especially with respect to bone erosion. Protection was accompanied by a reduction in synovial CD4+Foxp3+ Tregs that displayed preserved suppressive capacity and aerobic metabolism but aberra...
FYI, limitations are being proposed for Epidural Injection as treatment option for chronic pain This proposed LCD on Epidural Procedures for Pain Management services was announced on June 10, 2021. This nationwide policy contains many onerous changes that will detrimentally affect patient access to care. ASIPP is aware and already contacting congress members, but getting your patients to complain can also help. Please see below for important points but one of the bigger points... Read more
So I'm an applicant for this cycle to pain. I've been fortunate enough to receive 10ish interviews. Im an average applicant and therefore my interviews were from average programs. None of the BWHs and CCs for me. I'm having a hard time coming up with a rank list. I keep wanting to change things around. There is so little information about fellowships outside of interviews that its becoming hard for me to make decisions. Those of you that have gone through the process, what would you... Read more
Anesth/interventional pain MD: Started out at roughly $550K in another state, quit and started up a clinic in Houston ~1.5 years ago. Purchased our building and c-arm. The first year's been tough (credentialing was slow during Covid), but family support and savings (plus having paid off all loans) is helping the start-up efforts now, though growth has been slow. Roughly 50 pts a week, mix of FUs, NPs and some procedures. Mixed payors. Suggestions from any established self-employed solo... Read more
STATINS side effects can include muscle pain, diarrhoea or headaches. Certain foods or drinks consumed may increase your risk of statin side effects.
ConclusionsPatients with NFAI and 1-mg ODST ≤ 1.8 μg/dl presented higher odds of T2DM and higher levels of FBG and HOMA index than healthy controls.
ConclusionsThis study shows that vitamin D3 content is associated with the incidence of diabetes in people with high level of uric acid. This study offers a fresh perspective on the elements that influence the etiology of diabetes in hyperuricemia patients.
More News: Allergy & Immunology | Autoimmune Disease | Boys | Cancer & Oncology | Child Abuse | Children | Chronic Pain | Circumcision | Constipation | Corticosteroid Therapy | Cystitis | Databases & Libraries | Dermatology | Diabetes | Education | Endocrinology | Enterobiasis | Hives | Hypopigmentation | Laboratory Medicine | Learning | Lichen Planus | Lichen Sclerosus | OBGYN | Pain | Pain Management | Pediatrics | Rare Diseases | Sexual Abuse | Skin | Sleep Disorders | Sleep Medicine | Thyroid | UK Health | Universities & Medical Training | Urinary Tract Infections | Urology & Nephrology | Vitiligo | Women