Baylor St. Luke's Medical Center (BSLMC) is the private adult teaching hospital of Baylor College of Medicine jointly owned with CHI St. Luke's Health. The medical staff at the hospital includes full-time Baylor faculty, as well as community physicians. The hospital was formerly known as St. Luke's Episcopal Hospital before its acquisition by Catholic Health Initiatives in 2013 and subsequent co-ownership agreement with Baylor in 2014. It is located on Bertner Boulevard in the Texas Medical Center in Houston. The hospital is an 850-bed institution that is also a clinical partner of the Texas Heart Institute.
BACKGROUND:Image-guided superficial radiation therapy (IGSRT) using a high resolution dermal ultrasound, is becoming a non-surgical highly effective treatment option for non-melanoma skin cancer (NMSC). In a previous study, we reported results from a multi-institutional study of 1616 patients with 2917 NMSC lesions treated with IGSRT showing a 99.3% rate of local control (LC) with mean follow-up of 16.06 months. METHODS:In this study, we analyze 133 additional lesions from 93 patients, as well as update previous findings with a longer follow-up duration, and perform subgroup analysis and Kaplan-Meier statistics. A retrospective analysis of 1709 patients with 3,050 Stage 0, I, and II NMSC lesions treated from 2017 to 2020 was performed. RESULTS:With image guidance, lesions received a median of 20 fractions of 50, 70, or 100 kilovoltage(kV) IGSRT. Average follow-up was 25.1 months with a maximum follow up of 65.6 months for the entire cohort. Sixty-eight patients expired, with deaths due to unrelated causes, who had no-evidence of disease (NED) at last follow-up prior to death, leading to Disease-Specific-Survival of 100% (Overall survival was 96%). Absolute LC of 99.2% was achieved in 3,027 of 3,050 lesions with overall absolute LC for BCC, SCC, and SCC-is being 99.0%, 99.2%, and 99.8%, respectively. As of January 2022, no other late complications were found. DISCUSSION:These updated results demonstrates that IGSRT should be considered a first-line option for the non-surgical treatment of NMSC as it continues to achieve low complication rates while maintaining a high level of LC.
Objectives: Insomnia is a common condition with limitations in treatment through cognitive behavioral or pharmacological therapies, including variable efficacy, side effects, and time commitment. Given the close association between the vestibular system and sleep regulation, this study aims to investigate whether patients with insomnia but without overt vestibular symptoms may have underlying vestibular dysfunction and whether addressing this dysfunction can ameliorate their sleep disturbances. Methods: This is a prospective, cross-sectional, and observational study that will enroll patients with chronic insomnia. Utilizing the International Classification of Sleep Disorders edition 3 for chronic insomnia diagnosis, we screen patients for exclusion of overt vestibular dysfunction via the Dizziness Handicap Inventory and rule out insomnia primarily caused by depression or anxiety using the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7. Subjects without these conditions undergo detailed vestibular function testing, including balance and gait assessments, Videonystagmography, video head impulse test, subjective visual vertical/horizontal, and ocular/cervical vestibular evoked myogenic potential. Vestibular dysfunction will be correlated with insomnia severity as measured by the Pittsburgh Sleep Quality Index (PSQI). Results: The primary outcome measures are the presence of insomnia patients with asymptomatic vestibular dysfunction (AVD) but not OVD and the relationship between the severity of vestibular dysfunction and the severity of insomnia as indicated by PSQI scores. The secondary outcome is investigating the types and prevalence of AVD in insomnia subjects. Conclusions: This study seeks to elucidate the impact of asymptomatic vestibular dysfunction (AVD) on insomnia and understand the types and prevalence of AVD in insomnia subjects. Outcomes would potentially change the diagnostic and therapeutic paradigms toward tailored vestibular-focused rehabilitation for insomnia improvement. TRIAL REGISTRATION: www.chictr.org.cn, identifier: ChiCRT2400085439.
Periocular skin is notably thinner than other areas of the body, making it more susceptible to environmental factors and topical medications. Conditions affecting this region often require specialized care due to their impact on quality of life and potential to impair vision. This review aims to address the unique characteristics, diagnostic challenges, and therapeutic strategies for oculocutaneous inflammatory conditions, offering guidance for dermatologists in managing this specialized area of skin. A literature search was conducted on PubMed reviewing the most relevant periocular inflammatory conditions, including glandular and eyelid inflammation, conjunctival and corneal disorders, allergic and irritant contact dermatitis, autoimmune diseases, and infections. Key diagnostic and therapeutic approaches are highlighted to assist in effective patient management. Inflammatory oculocutaneous diseases stem from various causes, including eczematous dermatoses, infections, autoimmune conditions, meibomian gland dysfunction. Treatments range from traditional options like warm compresses, antibiotics, and corticosteroids to newer approaches such as biologic therapies and intense pulsed light. These conditions are often associated with allergies, side effects of biologic drugs, and systemic diseases like atopic dermatitis, highlighting the need for accurate diagnosis, personalized treatment, and proper eyelid hygiene for effective management. Effective management of periocular inflammatory conditions can be challenging due to the unique anatomy of the area and often requires a targeted and specialized approach to treatment. Dermatologists are essential in diagnosing and managing oculocutaneous diseases. Collaboration with optometrists and ophthalmologists is often needed to ensure the best outcomes, as these conditions greatly affect patients’ quality of life and cosmetic appearance.
Sjögren's syndrome (SS) is one of the most common autoimmune disorders. The disorder primarily affects the exocrine glands of the eyes and mouth and is regularly associated with extraglandular manifestations. These extraglandular manifestations can range from pulmonary, cardiac, muscular, neurological, to vascular. As the disease progresses, a majority of SS patients eventually develop extraglandular manifestations. Approximately 20% of patients with SS will develop pulmonary manifestations. However, it is uncommon to have the presenting symptoms be extraglandular and even less common to have multiple organs involved or critical illness. We present the case of a 42-year-old female whose only presenting symptoms were extraglandular, affecting multiple organs and leading to critical illness.
