Research Spotlight

Fallahzadeh, M. A. and J. F. Trotter (2020). “An Experiment of Nature: HBV-naive Recipients Receiving Liver Grafts With HBV Core Antibody-positive Donors Without Antiviral Prophylaxis.” Transplantation 104(8): e245-e246.

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Transplantation of livers from donors who are hepatitis B core antibody (HBcAb) positive and hepatitis B surface antigen (HBsAg) negative is a standard practice occurring in about 5% of the US liver transplants (LTs).1,2 Current guidelines recommend lifelong oral antiviral prophylaxis to prevent viral reactivation reported in up to 78% of untreated recipients.1,3 We report a series of HBsAg-negative LT recipients who received an organ from HBcAb-positive donors without receiving antiviral prophylaxis through an administrative error. [No abstract; excerpt from article].

Elmets, C. A., N. J. Korman, E. F. Prater, E. B. Wong, R. N. Rupani, D. Kivelevitch, A. W. Armstrong, C. Connor, K. M. Cordoro, D. M. R. Davis, B. E. Elewski, J. M. Gelfand, K. B. Gordon, A. B. Gottlieb, D. H. Kaplan, A. Kavanaugh, M. Kiselica, D. Kroshinsky, M. Lebwohl, C. L. Leonardi, J. Lichten, H. W. Lim, N. N. Mehta, A. S. Paller, S. L. Parra, A. L. Pathy, M. Siegel, B. Stoff, B. Strober, J. J. Wu, V. Hariharan and A. Menter (2020). “Joint AAD-NPF Guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures.” J Am Acad Dermatol 2020 Jul 30;S0190-9622(20)32288-X. [Epub ahead of print.].

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Psoriasis is a chronic, inflammatory, multisystem disease which affects up to 3.2% of the U.S population. This guideline addresses important clinical questions that arise in psoriasis management and care and provides recommendations based on the available evidence. The treatment of psoriasis with topical agents and with alternative medicine (AM) will be reviewed, emphasizing treatment recommendations and the role of dermatologists in monitoring and educating patients regarding benefits as well as risks that may be associated. This guideline will also address the severity assessment methods of psoriasis in adults.

Dutton, R. P., T. E. Grissom and F. Herbstreit (2020). “COVID-19 and Trauma Care: Improvise, Adapt, and Overcome!” Anesth Analg 131(2): 323-325.

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The global coronavirus pandemic has affected every aspect of modern life, including health care, yet few specialties are so directly affected as trauma anesthesiology. Quieter city streets with less vehicular traffic have reduced the volume of trauma cases, but injured patients now pose a unique new challenge: the risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-COV-2).1 The need for infection control measures, superimposed on the need for rapid treatment, has forced the development of new protocols. [No abstract; excerpt from Editorial].

Dixon, M. K., C. L. Dayton and G. M. Anstead (2020). “Parinaud’s Oculoglandular Syndrome: A Case in an Adult with Flea-Borne Typhus and a Review.” Trop Med Infect Dis 5(3).

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Parinaud’s oculoglandular syndrome (POGS) is defined as unilateral granulomatous conjunctivitis and facial lymphadenopathy. The aims of the current study are to describe a case of POGS with uveitis due to flea-borne typhus (FBT) and to present a diagnostic and therapeutic approach to POGS. The patient, a 38-year old man, presented with persistent unilateral eye pain, fever, rash, preauricular and submandibular lymphadenopathy, and laboratory findings of FBT: hyponatremia, elevated transaminase and lactate dehydrogenase levels, thrombocytopenia, and hypoalbuminemia. His condition rapidly improved after starting doxycycline. Soon after hospitalization, he was diagnosed with uveitis, which responded to topical prednisolone. To derive a diagnostic and empiric therapeutic approach to POGS, we reviewed the cases of POGS from its various causes since 1976 to discern epidemiologic clues and determine successful diagnostic techniques and therapies; we found multiple cases due to cat scratch disease (CSD; due to Bartonella henselae) (twelve), tularemia (ten), sporotrichosis (three), Rickettsia conorii (three), R. typhi/felis (two), and herpes simplex virus (two) and single cases due to tuberculosis, paracoccidioidomycosis, Yersinia enterocolitica, Pasteurella multocida, Chlamydia trachomatis, Epstein-Barr virus, and Nocardia brasiliensis. Preauricular lymphadenopathy is a common clinical clue for POGS and is unusual in viral and bacterial conjunctivitis. For POGS, the major etiological consideration is B. henselae, which is usually diagnosed by the indirect immunofluorescence serologic technique. Although CSD POGS is usually self-limited, oral azithromycin may hasten resolution. However, other possible etiologies of POGS may also arise from cat or cat flea contact: sporotrichosis, tularemia, Pasteurella multocida, or FBT. If there is no cat contact, other epidemiologic and clinical findings should be sought, because several of these conditions, such as tularemia, paracoccidioidomycosis, and tuberculosis, may have grave systemic complications. Although there are usually no long-term ocular sequelae if POGS is properly diagnosed, it still may cause prolonged ocular discomfort and require multiple physician contacts.

Deignan, J. L., C. Astbury, G. R. Cutting, D. Del Gaudio, A. R. Gregg, W. W. Grody, K. G. Monaghan and S. Richards (2020). “CFTR variant testing: a technical standard of the American College of Medical Genetics and Genomics (ACMG).” Genet Med 22(8): 1288-1295.

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Pathogenic variants in the CFTR gene are causative of classic cystic fibrosis (CF) as well as some nonclassic CF phenotypes. In 2001, CF became the first target of pan-ethnic universal carrier screening by molecular methods. The American College of Medical Genetics and Genomics (ACMG) recommended a core panel of 23 disease-causing variants as the minimal set to be included in pan-ethnic carrier screening of individuals with no family history of the disease, and these variants were usually assessed using targeted methods. The original recommendation also left open the option for laboratories to offer expanded CFTR variant panels; however, at the time, expanded CFTR variant panels were met with some controversy on the basis of the available technologies and the limited phenotypic knowledge of rare variants. Both of those aspects have now evolved, prompting this update of the ACMG technical standards for CFTR variant testing.