Inova Alexandria Hospital is a not-for-profit hospital in Alexandria, Virginia, United States. Founded in 1872 as the Alexandria Infirmary, it became part of Northern Virginia's Inova Health System in 1997. The hospital is notable for its early contributions in the field of emergency medicine, introducing a 24-hour-a-day emergency department staffed by physicians that has since become the model for emergency care in the United States.
BACKGROUND:Post-thrombotic syndrome is common after deep-vein thrombosis and can cause severe symptoms involving the limbs that impair patients' activity and quality of life. Endovascular therapy can eliminate chronic venous obstruction and is hypothesized to reduce the severity of post-thrombotic syndrome. METHODS:We randomly assigned 225 patients with moderate or severe post-thrombotic syndrome and imaging-confirmed iliac-vein obstruction to receive endovascular therapy (iliac-vein stent placement and enhanced antithrombotic therapy) plus standard post-thrombotic syndrome care or standard post-thrombotic syndrome care alone. The severity of post-thrombotic syndrome at 6 months (the primary outcome) was assessed with the validated Venous Clinical Severity Score (VCSS) tool (scores range from 0 to 30, with higher scores indicating more severe post-thrombotic syndrome) by evaluators who were unaware of the group assignments. Key secondary outcomes included venous disease-specific and overall quality of life. RESULTS:At 6 months, the severity of post-thrombotic syndrome was lower in the endovascular-therapy group than in the no-endovascular-therapy group (mean [±SD] VCSS, 8.1±5.1 vs. 10.0±4.9; adjusted difference, -2.0; P = 0.001). Venous disease-specific quality of life as assessed with the Venous Insufficiency Epidemiological and Economic Study Quality of Life questionnaire was better in the endovascular-therapy group than in the no-endovascular-therapy group at 6 months (adjusted difference, 14.5 points; P<0.001), as was overall quality of life as assessed with the Medical Outcomes Study 36-Item Short-Form Health Status Survey physical component summary score (adjusted difference, 6.1 points; P<0.001); scores on both tools range from 0 to 100. Through 6 months, bleeding was more common in the endovascular-therapy group than in the no-endovascular-therapy group (in 11.6% vs. 3.6% of the patients; P = 0.03). CONCLUSIONS:Among patients with moderate or severe post-thrombotic syndrome and iliac-vein obstruction, endovascular therapy led to less severe post-thrombotic syndrome and better health-related quality of life than standard care over a 6-month period but with a higher risk of bleeding. (Funded by the National Heart, Lung, and Blood Institute and others; C-TRACT ClinicalTrials.gov number, NCT03250247.).
BACKGROUND:Prostate cancer is the most common male malignancy, yet prevention and early detection efforts show inconsistent uptake worldwide. AIM:To identify which strategies and contextual factors enhance, or hinder, the effectiveness of prostate cancer prevention and screening. METHODS:An integrative review yielded 19 peer-reviewed studies. Quality was appraised using Critical Appraisal Skills Programme; data were thematically synthesised. RESULTS:Five themes surfaced. (1) Cultural attitudes-fear of digital rectal examination reduces participation, but tailored messaging can overcome this resistance. (2) Chemoprevention-finasteride and dutasteride cut incidence of prostrate cancer by ≈25 %, however, there are side effects which must be managed. (3) Biomarkers-the prostate-specific antigen test is the most widely used screening test, but the prostate cancer antigen 3 test is more accurate but increases costs. (4) Access models-mobile units, mass screening and theory-based education triple to six-fold prostate-specific antigen uptake in under-served groups, showing that low-barrier delivery can offset stigma. (5) Lifestyle-low-fat diets and micronutrients offer modest protection against prostate cancer, while obesity raises high-grade risk, highlighting synergy between behavioural and clinical interventions. CONCLUSION:Integrating accurate diagnostics, culturally sensitive education, low-barrier outreach and lifestyle counselling offers the strongest pathway to equitable, sustainable prostate cancer control. Future studies should evaluate cost effectiveness and long-term adherence in diverse settings.
Introduction Para-phenylenediamine (PPD) is a compound in commercial dark hair dyes and henna tattoos. It is commonly responsible for type IV hypersensitivity allergic contact dermatitis that develops several hours after exposure and may worsen on subsequent exposures. It is more commonly recognized after reactions occurring on the scalp or after temporary tattoos. Case Summary A 40-year-old male applied an instant hair dye shampoo to the facial hair surrounding his mouth. Upon his presentation to the emergency department he displayed circumferential swelling around the mouth suggestive of angioedema. Careful history and exam revealed a recent exposure and reaction to PPD. He was treated supportively by washing the skin and with antihistamines. Discussion PPD exposures may be less often recognized in men, those with darker skin pigmentation or when applied in a local area less commonly associated with hair dyeing. Conclusion PPD exposures may be recognized after physical exam revealing edema localized to hair or recent dye exposure and thorough history.
