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Background. Standard protocol to detect melanoma relies on visual assessment in which the sensitivity and specificity are low for early melanomas. Pigmented lesion assay (PLA) offers objective metrics to aid in determining suspicious lesions; however, the literature on the diagnostic accuracy is controversial. Methods. To assess the performance of PLA, we retrospectively assessed the diagnostic accuracy using two different cohorts, total (n = 426) and biopsied (n = 96), modifying the definition of true negative for each. Sensitivity, specificity, negative predictive value, positive predictive value, prevalence, and Cohen’s kappa were calculated. Results. 370 PLA (−) lesions and 56 in the PLA (+). Of the 40 PLA (−) lesions that were biopsied, 5 (12.5%) were diagnosed as melanoma and 16 (40.0%) were atypical melanocytic nevus. Of the 56 PLA (+) lesions, 14 (25.0%) were melanoma, of which 10 (71.4%) were double positive, 3 (21.4%) were PRAME only, and 1 (7.1%) was LINC only. For the total cohort (n = 426), sensitivity of 73.7%, specificity of 89.7%, NPV of 98.6%, PPV of 25.0%, prevalence of 4.5%, accuracy of 89.0%, and kappa agreement of 0.329 were calculated. The biopsied cohort revealed the same sensitivity and PPV; however, specificity was 45.5%, accuracy was 51.0%, NPV was 87.5%), and kappa agreement was 0.110. Conclusion. There differences in our study seen between cohorts highlight the importance to recognize that neither findings are perfect. The real value likely falls in between, but further studies are needed.

A 31-gene expression profile (31-GEP) test that predicts metastatic risk in patients with cutaneous malignant melanoma (CMM) has previously been validated and is available for clinical use. The test dichotomizes patients into lower risk and higher risk groups based on differences that correspond to unique genetic expression patterns. Although the impact of such a test on dermatology providers' clinical decision-making has been studied, little is known about whether there exists an association between certain clinical features, such as dermoscopy, and 31-GEP results.In this retrospective analysis of 31-GEP test results ordered by dermatologists, we evaluated the frequency of dermoscopic features, using a modified dermoscopy three-point checklist, in 17 cases (n=17) and compared these findings to other key clinicopathologic features including tumor thickness, ulceration, and mitotic rate to 31-GEP results. Additionally, we evaluated the dermatologist's perspective and incorporation of GEP testing as part of patient discussion on melanoma management.31-GEP stratified patients into 4 groups; groups 1A and 1B are considered low risk of metastasis or recurrence, while 2A and 2B are considered high risk. Of the 17 cases, we had fifteen group 1A (88.23%), one 1B (5.88%), and one 2B (5.88%) result. Overall frequency of dermoscopic features is as follows; 100% of lesions presented with asymmetry, 47% with round structures, and 70.6% with blue-white color. The average time providers spent explaining and ordering the test was 15 minutes, with a range of 10 to 20 minutes.This study represents our experience and understanding of the dermatologistrsquo;s role ordering 31-GEP in the care pathway of melanoma patients and we recommend that dermatology providers consider ordering the test for newly diagnosed CMM patients. J Drugs Dermatol. 2022;21(12): doi:10.36849/JDD.6889.

A partir de uma etnografia realizada entre usuários de tornozeleiras no sistema de monitoramento eletrônico no Sul do Brasil, exploramos a noção da “infraestrutura do cuidado” para entender por que, em certos casos, o dispositivo não parece alcançar os objetivos projetados nem do sistema judiciário nem dos apenados. Nossa análise inspira-se no trabalho de Maria Puig de la Bellacasa, que encoraja pesquisadores a resgatar a noção de cuidado das garras de perspectivas idealizadas – isto é, de visões normativas descrevendo um trabalho abnegado por cuidadores perfeitos. No intuito de restituir seu pleno potencial político, abraçamos uma abordagem não inocente da noção de cuidado que adentra os terrenos tóxicos das dinâmicas de poder e exclusão. Olhando em particular para a organização das atividades domésticas, atentamo-nos para os atos e atores normalmente invisibilizados dos presos em regime do semiaberto. Perguntamos quais as práticas que facilitam ou, pelo contrário, travam as engrenagens do sistema que rege a vida desses usuários de tornozeleiras. Com isso, esperamos realizar três objetivos: sublinhar o caráter coletivo da estrutura do cuidado, aumentar a visibilidade de coisas e pessoas previamente negligenciadas, e finalmente acrescentar densidade à nossa apreensão das consequências reais de certo artefato tecnológico para o universo heterogêneo de apenados. Through the ethnographic study in Southern Brazil of prisoners in semi-liberty subjected to electronic monitoring, we explore the notion of “infrastructures of care” to understand why, in certain cases, the device does not seem to achieve hoped-for objectives -- neither those of the judicial system nor those of the prisoners themselves. Our analysis is inspired by the work of Maria Puig de la Bellacasa, who exhorts researchers to rescue the notion of care from the clutches of idealized perspectives – that is, from normative perspectives describing selfless work by perfect caregivers. In order to restore the notion of care to its full political potential, we embrace a “non-innocent” approach that penetrates into the toxic terrains involved in the dynamics of power and exclusion. Focusing mainly on the organization of the anklet-wearers’ domestic activities, we highlight the often “invisible” acts and actors that facilitate or, on the contrary, gum up the gears of the system that governs their lives. Altogether, ours is a three-fold objective, aiming to underline the collective nature of the structures of care, to enhance the visibility of previously neglected people and things, and finally to add new layers to our understanding of the real-life consequences of a certain technological artifact for the heterogeneous universe of inmates.

Through the ethnographic study in Southern Brazil of prisoners in semi-liberty subjected to electronic monitoring, we explore the notion of “infrastructures of care” to understand why, in certain cases, the device does not seem to achieve hoped-for objectives -- neither those of the judicial system nor those of the prisoners themselves. Our analysis is inspired by the work of Maria Puig de la Bellacasa, who exhorts researchers to rescue the notion of care from the clutches of idealized perspectives – that is, from normative perspectives describing selfless work by perfect caregivers. In order to restore the notion of care to its full political potential, we embrace a “non-innocent” approach that penetrates into the toxic terrains involved in the dynamics of power and exclusion. Focusing mainly on the organization of the anklet-wearers’ domestic activities, we highlight the often “invisible” acts and actors that facilitate or, on the contrary, gum up the gears of the system that governs their lives. Altogether, ours is a three-fold objective, aiming to underline the collective nature of the structures of care, to enhance the visibility of previously neglected people and things, and finally to add new layers to our understanding of the real-life consequences of a certain technological artifact for the heterogeneous universe of inmates., A partir de uma etnografia realizada entre usuários de tornozeleiras no sistema de monitoramento eletrônico no Sul do Brasil, exploramos a noção da “infraestrutura do cuidado” para entender por que, em certos casos, o dispositivo não parece alcançar os objetivos projetados nem do sistema judiciário nem dos apenados. Nossa análise inspira-se no trabalho de Maria Puig de la Bellacasa, que encoraja pesquisadores a resgatar a noção de cuidado das garras de perspectivas idealizadas – isto é, de visões normativas descrevendo um trabalho abnegado por cuidadores perfeitos. No intuito de restituir seu pleno potencial político, abraçamos uma abordagem não inocente da noção de cuidado que adentra os terrenos tóxicos das dinâmicas de poder e exclusão. Olhando em particular para a organização das atividades domésticas, atentamo-nos para os atos e atores normalmente invisibilizados dos presos em regime do semiaberto. Perguntamos quais as práticas que facilitam ou, pelo contrário, travam as engrenagens do sistema que rege a vida desses usuários de tornozeleiras. Com isso, esperamos realizar três objetivos: sublinhar o caráter coletivo da estrutura do cuidado, aumentar a visibilidade de coisas e pessoas previamente negligenciadas, e finalmente acrescentar densidade à nossa apreensão das consequências reais de certo artefato tecnológico para o universo heterogêneo de apenados.

Background A pigmented lesion assay (PLA) is used to non-invasively detect the presence of three genes associated with melanoma (LINC00518, PRAME, and TERT) using adhesive patch testing and has the potential to reduce unnecessary biopsies. However, few studies have evaluated the clinical applicability of PLA testing and its potential limitations in real-world practice. We aim to identify possible barriers that inhibit the clinical utility of PLA testing by dermatologists. Methods Retrospective case-control study analyzing the PLA testing by two pigmented-lesion specialists that underwent PLA testing as part of clinical management. Data was collected from April 2021 to April 2022 from an academic tertiary-level center. Results The total cohort consists of 472 lesions. Genetic analysis failure for LINC00518 and PRAME occurred in 12.5% of cases and in 70.9% of cases for TERT. In 38.5% of cases, PLA results were discrepant with histopathology. The additional time associated with PLA use independent from the patient's visit was 15 min on average. Conclusion The high proportion of non-actionable results and discrepant cases highlights potential barriers to the widespread adoption of PLA testing. The high proportion of genetic analysis failure seen for TERT and limited influence on the proposed risk suggests TERT does not offer significant clinical value.

Environmental carcinogenic exposures are major contributors to global disease burden yet how they promote cancer is unclear. Over 70 years ago, the concept of tumour promoting agents driving latent clones to expand was first proposed. In support of this model, recent evidence suggests that human tissue contains a patchwork of mutant clones, some of which harbour oncogenic mutations, and many environmental carcinogens lack a clear mutational signature. We hypothesised that the environmental carcinogen

Long-term cognitive impairment (LTCI) is a phenomenon predominantly seen in patients within intensive care units (ICU) that causes chronic dysfunction, defined as new or worsening deficits in memory, attention, mental processing speed, executive function, intellectual function, and visual-spatial abilities for over 12 months, inhibiting the necessary return to baseline function without appropriate intervention. Our objective is to provide a guideline of nursing strategies to reduce LTCI through different studies that evaluate pharmacological and non-pharmacological methods. Current literature demonstrates that pharmacotherapy focused on neuronal protection as well as robust physical therapy regimens and regulated sleep schedules show promise in strengthening cognitive function and reducing LTCI. Future studies regarding LTCI should focus on the efficacy of specific pharmacological regimens, large-scale assessments of the implementation of physical therapy to reduce LTCI, as well as, specific interventions to reduce the incidence of delirium in the ICU.

Anticholinergics, such as benztropine and trihexyphenidyl, are a class of medications that have been used to treat several different conditions including antipsychotic-induced extrapyramidal side effects (EPS) that are most often associated with first-generation antipsychotics (FGAs), such as haloperidol and fluphenazine. Many other medications, including antimuscarinics, antipsychotics, and antidepressants, also have anticholinergic effects. In this report, we review the case of an 80-year-old male who experiences irreversible anticholinergic withdrawal effects following the discontinuation of trihexyphenidyl and trospium secondary to side effects. Discontinuation of anticholinergics must be approached with care as abrupt withdrawal can lead to cholinergic rebound and muscular rigidity, and in some cases can lead to acute hospitalization and an inability to return to baseline functioning, as seen in our elderly patient. Keywords: Anticholinergic withdrawal, trihexyphenidyl, trihexyphenidyl withdrawal, trospium, anticholinergic drugs, cholinergic rebound