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Introduction: Uncertainty surrounds the optimal routine laboratory monitoring in acne patients treated with isotretinoin. Objective: Our aim was to evaluate the risk of mild and severe laboratory abnormalities in patients with acne starting isotretinoin versus oral antibiotic treatment. Methods: A global population‐based retrospective cohort study assigned two groups of patients with acne‐prescribed isotretinoin (n = 79,012) and oral antibiotics (n = 79,012). Comprehensive propensity‐score matching was conducted. Results: Compared to acne patients treated with oral antibiotics, those under isotretinoin demonstrated an increased risk of grade ≥3 hypertriglyceridemia (hazard ratio [HR], 7.85; 95% confidence interval [CI], 5.58–11.05; P < 0.001) and grade ≥3 elevated aspartate transaminase (AST) levels (HR, 1.45; 95% CI, 1.13–1.85; P = 0.003) within the initial 3 months of treatment. The absolute risk of these abnormalities among isotretinoin initiators was 0.4% and 0.2%, respectively. The risk difference of these findings was clinically marginal: 3 and 1 additional cases per 1,000 patients starting isotretinoin, respectively. There was no significant risk of grade ≥3 impairment in cholesterol, alanine transaminase, gamma‐glutamyl transferase, or creatinine levels under isotretinoin. Most laboratory abnormalities were documented 1–3 months after drug initiation in time‐stratified analysis. Conclusion: Isotretinoin is associated with a clinically marginal increased risk of severe hypertriglyceridemia and hypertransaminasemia. Routine blood testing should be performed 1–3 months after commencing therapy. [ABSTRACT FROM AUTHOR]

Background: Wide neck bifurcation aneurysms (WNBAs) are a subtype of aneurysms that are especially complex to treat. We aim to conduct a systematic review and meta-analysis to synthesize the available literature on the safety and efficacy of employing endovascular clip system (eCLIPs) in the treatment of WNBAs. Methods: We report this study in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines. PubMed, Embase, Web of Science, and Scopus were queried for this review. Screening and extraction were performed by at least two authors to ensure accuracy and completeness, and a senior author arbitrated any discrepancies. All data were analyzed using R software version 4.3.0. and random-effects model. Results: Four studies were finally included, of which three were prospective and one was retrospective. Successful adjunctive coiling occurred in 91.38% (95% CI = 70.71–97.9) of cases and overall technical success was achieved in 88.61% (95 CI = 75.54–95.15) of cases. The pooled complete occlusion (Raymond-Roy Class I) was 50.65% (95% CI = 39.63–61.60) and adequate occlusion (Raymond-Roy Class I/II) was 84.42% (95% CI = 74.53–90.93). Thrombo-embolic complication had a pooled rate of 1.22% (95% CI = 0.17–8.15), retreatment rate was 6.10% (95% CI = 2.56–13.83), and mortality reported in 3.66% (95% CI = 1.18–10.74) of patients. Conclusion: The use of eCLIPs may be a safe and efficacious treatment for WNBAs. Future randomized controlled trials are needed for further validation of the findings. [ABSTRACT FROM AUTHOR]

Background: Cancer risk after long‐term exposure to interleukin (IL)‐23 inhibitors (IL‐23i) and IL‐17 inhibitors (IL‐17i) remains to be delineated. Objective: To evaluate the risk of malignancies in patients with psoriasis treated with IL‐23i and IL‐17i relative to those prescribed tumour necrosis factor inhibitors (TNFi) during the first 5 years following drug initiation. Methods: A global population‐based cohort study included two distinct analyses comparing patients with psoriasis under different therapeutic modalities; (i) new users of IL‐17i(n = 15,331) versus TNFi (n = 15,331) and (ii) new users of IL‐23i (n = 5832) versus TNFi (n = 5832). Results: Patients prescribed IL‐17i experienced a decreased risk of non‐Hodgkin lymphoma (NHL; HR, 0.58; 95% CI, 0.40–0.82; p = 0.002), colorectal cancer (HR, 0.68; 95% CI, 0.49–0.95; p = 0.024), hepatobiliary cancer (HR, 0.68; 95% CI, 0.58–0.80; p < 0.001), ovary cancer (HR, 0.48; 95% CI, 0.29–0.81; p = 0.005), melanoma (HR, 0.52; 95% CI, 0.37–0.73; p < 0.001), and basal cell carcinoma (BCC; HR, 0.57; 95% CI, 0.48–0.67; p < 0.001). IL‐23i was associated with a reduced risk of NHL (HR, 0.39; 95% CI, 0.19–0.78; p = 0.006), hepatobiliary cancer (HR, 0.44; 95% CI, 0.31–0.62; p < 0.001) and BCC (HR, 0.76; 95% CI, 0.57–0.99; p = 0.046). In a sensitivity analysis comparing patients managed by IL‐17i and IL‐23i with their biologic‐naïve counterparts, these classes were associated with decreased risk of several malignancies. Conclusion: IL‐17i and IL‐23i are associated with decreased risk of several malignancies. These findings should be considered prior to the prescription of biologics. [ABSTRACT FROM AUTHOR]

Bevacizumab (BCZ), commercially known as Avastin, is a monoclonal antibody that targets vascular endothelial growth factor (VEGF). Initially recognized as a breakthrough in oncology, it has since gained FDA approval for various ocular conditions and more recently, for the treatment of glioblastoma multiforme (GBM). Bevacizumab's ability to inhibit excessive neovascularization suggests it may have a potential role in treating chronic subdural hematomas (cSDH). Recent studies have shown that the pathophysiology of cSDH is more complex than previously understood, with VEGF concentrations in subdural fluid significantly exceeding those in serum, contributing to the high recurrence rates. Intra-arterial administration of bevacizumab has shown promising results in recent case series against chronic subdural hematoma, and may be a viable alternative to middle meningeal artery embolization. If successful, this treatment could significantly decrease the rate of recurrence and result in lower rates of severe neurological complications such as visual loss. This literature review explores the connection between bevacizumab and cSDH, focusing on the pharmacological, safety, and delivery aspects of this approach while summarizing the current evidence supporting its use. [ABSTRACT FROM AUTHOR]

Keloids result from uncontrolled inflammation and fibrosis during wound healing. Vitamin D can regulate skin proliferation and inflammation. Fibroblasts are vitamin D‐responsive target cells and are source of koebnerisin (an antimicrobial peptide released during inflammation and wound healing). This study aimed to assess the levels and correlations between the serum and tissue 25‐Hydroxyvitamin D, tissue vitamin D receptors, and serum and tissue koebnerisin (S100A15) in patients with keloids. Nineteen patients with keloids and 20 matched controls were recruited. From each keloid patient, a serum sample and two biopsies were taken from the keloid (lesional) (Tissue A) and from normal skin (non‐lesional) (Tissue B). From controls, a serum sample and a tissue biopsy from normal skin were taken. Serum and tissue 25‐Hydroxyvitamin D, tissue vitamin D receptors, and serum and tissue koebnerisin were measured in retrieved samples using ELISA. Results revealed a significantly lower serum 25‐Hydroxyvitamin D, tissue vitamin D receptors, as well as, serum and tissue koebnerisin in keloid patients compared to controls. Tissue 25‐Hydroxyvitamin D was significantly lower in keloidal skin biopsy (Tissue A) compared to non‐lesional normal skin biopsy (Tissue B). Tissue koebnerisin showed a significant positive correlation with tissue vitamin D receptors, and a significant negative correlation with tissue 25‐Hydroxyvitamin D. There was a significant negative correlation between serum 25‐Hydroxyvitamin D and duration of keloid. Accordingly, low serum and tissue 25‐Hydroxyvitamin D and deficient tissue vitamin D receptors contribute to the pathogenesis of keloids. This can be partly mediated by dysregulation of the antimicrobial peptide; koebnerisin. Artificial antimicrobial peptides and koebnerisin‐modifying drugs, for example, vitamin D and TNF‐α inhibitors can have a role in keloid prevention and treatment. [ABSTRACT FROM AUTHOR]

Cerebral sinus venous thrombosis (CSVT) has traditionally been treated medically with systemic anticoagulation. Recent advances in endovascular therapy (EVT) may represent an alternative treatment to medical therapy for CSVT. We conducted a systematic review and meta-analysis to evaluate the use of EVT for CSVT.We conducted a systematic literature review using PubMed, Embase, Scopus, and Web of Science. We included studies that reported outcomes following EVT for CSVT. The primary outcome of interest was rate of modified Rankin Scale (mRS) 0–2. Secondary outcomes of interest were rates of complete, partial, and failed recanalization, mortality, and new or expansion of hematoma. We calculated pooled rates (%) and their corresponding 95% confidence intervals (CIs).Thirty-eight studies with 682 patients were included. Rate of mRS 0–2 was 82.6% (95% CI, 75.3%–88.0%). Rate of complete recanalization was 60.9% (95% CI, 49.1%–71.5%), rate of partial recanalization was 34.2% (95% CI, 24.1%–45.9%), and rate of failed recanalization was 5.4% (95% CI, 3.1%–9.2%). Rate of mortality was 6.7% (95% CI, 4.1%–10.8%), and rate of new hematoma or expansion of hematoma was 5.1% (2.9%–8.8%).In this systematic review and meta-analysis, EVT for CSVT was associated with favorable rates of mRS 0–2 and recanalization. Furthermore, EVT was associated with a promising safety profile. Future prospective, comparative studies are warranted to assess EVT for CSVT. [ABSTRACT FROM AUTHOR]

Cytokine blocking therapies have revolutionized the management of psoriasis and atopic dermatitis but can lead to the development of paradoxic psoriasis (PP). Patients treated with biologics should be closely monitored for the development of PP and other paradoxical eruptions (including inflammatory joint disease, inflammatory bowel disease, eczematous eruptions, lupus like eruptions, sarcoidal eruptions, and others) and occasionally the development of cutaneous T-cell lymphoma. Further understanding the immunologic mechanism of these processes will ultimately drive our understanding of and ability to predict and manage PPs., Competing Interests: Disclosure There are no funding sources. M. Abdelghaffar, S. Kottilil, and M.J. Murphy have nothing to disclose. J.M. Cohen serves on a data and safety monitoring board for Advarra and has received consulting fees from Novartis. W. Damsky has received research support from Pfizer, United States, Advanced Cell Diagnostics/Bio-techne, AbbVie, United States, Incyte, United States, and Bristol-Myers Squibb, United States; receives consulting fees from Eli Lilly, TWI Biotechnology, Incyte, Epiarx Diagnostics, Bristol Myers Squibb, and Boehringer Ingelheim; and receives licensing fees from EMD/Millipore/Sigma., (Copyright © 2024 Elsevier Inc. All rights reserved.)