Sweet Syndrome and Neutrophilic Dermatosis of the Dorsal Hands

Sweet syndrome is a rare cutaneous condition with a broad clinical differential diagnosis. It can be classified into 3 subtypes: classic, malignancy-associated, and drug-induced. There are numerous associated disorders and provoking medications. Uncommonly, it can present as a multiorgan disease and cause significant morbidity. Systemic corticosteroids are the gold standard of treatment and yield rapid improvements in both lesions and symptoms. Nonsteroidal therapies may be effective alternatives, although high-quality comparative data are lacking. Some treatments for Sweet syndrome have paradoxically been implicated in the induction of disease.

Evaluation of Mid-term Outcomes Following Shoulder Hemiarthroplasty for Avascular Necrosis of the Humeral Head in Patients 40 Years and Younger

In order to evaluate postoperative function and failure rates among younger patients undergoing hemiarthroplasty for humeral head avascular necrosis (AVN), data from patients < 40 years treated between December 2008 - January 2018 was retrospectively analyzed. Pain was assessed preoperatively and at final follow up using a visual analogue scale (VAS). The American Shoulder and Elbow Surgeons (ASES) standardized assessment, single assessment numeric evaluation (SANE) score, and patient satisfaction were assessed at final follow up, as well as surgical revision rates. In total, eight shoulders were included in the final analysis, with a follow up of 6.6 + 3.6 years. Analysis indicated a statistical improvement in VAS pain (p = 0.001), while comparison of postoperative function between surgical and non-surgical limbs did not demonstrate statistical differences in SANE or ASES averages (p > 0.05). At final follow up, 25% of patients expressed dissatisfaction; however, there were no cases of revision surgery. In conclusion, younger patients undergoing hemiarthroplasty for humeral head AVN experienced pain improvement and no revisions at short-to-mid-term follow up, but one-in-four indicated dissatisfaction. Level of evidence: IV, case series. (Journal of Surgical Orthopaedic Advances 32(2):118-121, 2023).

Development and validation of a COVID-19 vaccine hesitancy scale for adults in the United States

COVID-19 vaccines have been rapidly developed. However, widespread uptake remains a hurdle to a successful pandemic response. A simple, user-friendly survey to measure vaccine hesitancy may facilitate development of interventions aimed at maximizing vaccination. We developed a novel 10-item instrument designed to measure COVID-19 vaccine hesitancy in adults in the United States. We recruited 232 participants through Amazon's Mechanical Turk, an online crowdsourcing platform. The internal consistency (Cronbach's α = 0.89) and temporal stability (r = 0.87; p < 0.001) of our survey was strong. Lower hesitancy (high scores) was associated with higher trust in physicians (r = 0.58; p < 0.001), and higher hesitancy (low scores) was reported with higher belief in conspiracies (r = -0.68; p < 0.001). The correlation between low hesitancy and reported intent to receive (or history of receiving) at least one dose of the COVID-19 vaccine was moderate-strong (r = 0.68; p < 0.001).

Reassurance Techniques Do Not Significantly Impact Confidence in Biosimilars for Psoriasis: A Survey of a Convenience Sample of Individuals with Self-Identified Psoriasis

INTRODUCTION

Biosimilars are underutilized, and negative perceptions may hinder their acceptance by patients. Psychologic interventions have not been extensively studied in the context of alleviating biosimilar hesitancy. The objective of this study was to assess the effectiveness of psychologic interventions on biosimilar confidence.

METHODS

Following institutional review board (IRB) approval, 1285 subjects with self-reported psoriasis were recruited using Amazon Mechanical Turk, an online crowdsourcing platform. Participants were randomized to one of ten groups. Group A started with a hypothetical bio-originator; group B started with a hypothetical biosimilar. The remaining groups were provided a hypothetical scenario in which they were switching to a biosimilar after achieving great results with a bio-originator, and were randomized to receive either no reassurance (group C) or one of the following psychologic interventions: reassurance of comparable effectiveness (group D), an illustration implying comparable effectiveness (group E), anecdote of great results obtained in "other psoriasis patients" (group F), anecdote of great results obtained in another psoriasis patient "a lot like you" (group G), reassurance of the rigorous evaluation process to gain Food and Drug Administration (FDA) approval (group H), engagement in a task designed to facilitate recognition of biosimilars' comparability through answering multiple choice (group I) or free response questions (group J). Confidence levels were assessed using six-point Likert scales and analyzed using one-way analysis of variance (ANOVA) and two-group t-tests.

RESULTS

While no statistically significant differences were detected, illustrations implying comparability (mean 4.19), explanations of the rigorous process to gain FDA approval (mean 4.21), testimonials of treatment success in another psoriasis patient "a lot like you" (mean 4.07) and "other psoriasis patients" (mean 4.01), and engagement with multiple choice (mean 4.02) and free response answers (mean 4.08) improved biosimilar confidence compared with the biosimilar switch control group (mean 3.96).

CONCLUSION

Identifying highly impactful methods of improving biosimilar confidence remains a challenge.

Assessing Behavioral Economic-Based Approaches to Address COVID-19 Vaccine Hesitancy

Supplemental Digital Content is Available in the Text.

Mycophenolate mofetil as adjunctive therapy to corticosteroids for the treatment of pyoderma gangrenosum: a case series and literature review

Pyoderma gangrenosum is a rare neutrophilic dermatosis that is commonly treated with systemic corticosteroids; however, their potent side effects may warrant tapering, and non-steroidal systemic immunosuppressants may help maintain or bolster disease clearance during weaning. Although cyclosporine is regarded as a favorable corticosteroid-sparing agent, it is associated with several side effects, such as renal toxicity and hypertension, that may limit its feasibility. Mycophenolate mofetil is a well-tolerated alternative with limited data. Institutional review board approval was obtained to review patients from a single institution who received mycophenolate mofetil for pyoderma gangrenosum between January 1, 2010, and December 31, 2019. A systematic MEDLINE (PubMed) review was performed of articles containing linked keywords: "mycophenolate mofetil" and "pyoderma gangrenosum". Patient demographics, presentation details, and treatment regimen characteristics were recorded. Fourteen of our pyoderma gangrenosum patients were treated with mycophenolate mofetil concomitantly with prednisone. Ninety-three percent of our patients achieved improvement within 12 months (mean 4.5 months), including five patients who experienced complete healing. Outcomes in literature patients were comparable; 77% either improved or maintained clearance with mycophenolate mofetil. Greater than 80% of total patients experienced healing or adequate disease control at a median dose of 2000 mg daily. The most common side effects of mycophenolate mofetil were myelosuppression and gastrointestinal upset, which were both seen in 18% of patients. Although this study is subject to publication bias, mycophenolate mofetil appears to be an efficacious and well-tolerated adjunctive therapy option for pyoderma gangrenosum.