One-year-old male Persian cat presented with multiple fractures and no known traumatic history. Marked decrease of bone radiopacity and thin cortices of all long bones were identified on radiography. Tentative diagnosis was osteogenesis imperfecta, a congenital disorder characterized by fragile bone. To determine bone mineral density (BMD), quantitative computed tomography (QCT) was performed. The QCT results revealed a mean trabecular BMD of vertebral bodies of 149.9 ± 86.5 mg/cm³. After bisphosphonate therapy, BMD of the same site increased significantly (218.5 ± 117.1 mg/cm³, p < 0.05). QCT was a useful diagnostic tool to diagnose osteopenia and quantify response to medical treatment.
Animals ; Bone Density ; Bone Diseases, Metabolic ; Cats* ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Diagnosis ; Fractures, Multiple ; Humans ; Male ; Osteogenesis Imperfecta ; Osteogenesis* ; Radiography

There are two forms of cryptococcal meningitis immune reconstitution inflammatory syndrome (CM-IRIS): paradoxical CM-IRIS and unmasking CM-IRIS. It is important to distinguish paradoxical CM-IRIS and CM relapse because mortality of CM-IRIS is higher than that of CM without IRIS, and paradoxical CM-IRIS and CM relapse requires different treatment. We report a case of paradoxical CM-IRIS that well matches the clinical findings with MR findings during three years follow-up of a HIV infected patient and new MRI finding is also introduced to help distinguish them.

Purpose: To identify the effects of 0.45% ketorolac tromethamine on intraocular pressure (IOP) after cataract surgery in glaucoma patients. Methods: A retrospective chart review of open angle glaucoma patients and controls who underwent cataract surgery (perfomed by a single surgeon) was conducted. Topical ketorolac was applied from the day before surgery until 1 month postoperatively. IOP and anterior chamber (AC) inflammation were assessed preoperatively and at 1 day, 1 month, and 3 months postoperatively. The incidence of IOP spikes was also measured. For comparative analysis, glaucoma patients were divided into ketorolac (G+K+) and non-ketorolac (G+K-) groups, while non-glaucoma patients were divided into G-K+ and G-K- groups. Results: A total of 243 eyes (243 patients) were enrolled. Among glaucoma patients, the initial postoperative IOP increase and IOP at 3 months postoperatively were lower for the G+K+ than G+K- group. In the G+K+ group, IOP remained low at 1 and 3 months postoperatively, while in the G+K- group, IOP did not change significantly compared to the preoperative values. Among non-glaucoma patients, there were no differences in IOP change until 3 months postoperatively between the G-K+ and G-Kgroups. AC inflammation was significantly lower at 1 week in the G+K+ than G+K- group. The incidence of IOP spikes during the first 3 months postoperatively was lower in the G+K+ than in the G+K- group. Conclusions Ketorolac had a positive effect on IOP after cataract surgery and allowed for a lower IOP to be maintained in glaucoma patients. Topical ketorolac may be used to prevent IOP elevation after cataract surgery in patients with advanced glaucoma or at high risk for severe AC inflammation.

Oronasal bleeding that continues despite oronasal packs or recurs after removal of the oronasal packs is referred to as intractable oronasal bleeding, which is refractory to conventional treatments. Severe craniofacial injury or tumor in the nasal or paranasal cavity may cause intractable oronasal bleeding. These intractable cases are subsequently treated with surgical ligation or endovascular embolization of the bleeding arteries. While endovascular embolization has several merits compared to surgical ligation, the procedure needs attention because severe complications such as visual disturbance or cerebral infarction can occur. Therefore, comprehensive understanding of the head and neck vascular anatomy is essential for a more effective and safer endovascular treatment of intractable oronasal bleeding.
Arteries ; Carotid Artery, External ; Cerebral Infarction ; Epistaxis ; Head ; Hemorrhage ; Ligation ; Neck

Background: Both verruca plana (VP) and seborrheic keratosis (SK) cause a major cosmetic concern. However, it is difficult to discriminate VP from SK presenting multiple tiny papules, especially those located on the face and neck. As VP and SK have different treatment strategies and prognoses, differentiation between them is important.
Objective
The objective of this study was to elucidate the clinical differential characteristics between VP and VP-like SK on the face and neck. Methods: We retrospectively investigated patients who underwent skin biopsy for differentiating between VP and VP-like SK. Multivariable logistic regression analysis was conducted to identify factors associated with the differential diagnosis. Results: Among 80 identified cases, 48.7% (n=39) was VP, and 51.3% (n=41) was VP-like SK. In the multivariable logistic regression analysis, larger than 3-mm, skin-like or pink lesion color, and confluent distribution were more likely to indicate VP than VP-like SK. Conclusion Our study proposed useful clinical differential characteristics between VP and VP-like SK on the face and neck in a large number of biopsy-proven cases. Still, there are exceptions. Therefore, in such confusing cases, skin biopsy to attain exact diagnosis is recommended.

Oronasal bleeding that continues despite oronasal packs or recurs after removal of the oronasal packs is referred to as intractable oronasal bleeding, which is refractory to conventional treatments. Severe craniofacial injury or tumor in the nasal or paranasal cavity may cause intractable oronasal bleeding. These intractable cases are subsequently treated with surgical ligation or endovascular embolization of the bleeding arteries. While endovascular embolization has several merits compared to surgical ligation, the procedure needs attention because severe complications such as visual disturbance or cerebral infarction can occur. Therefore, comprehensive understanding of the head and neck vascular anatomy is essential for a more effective and safer endovascular treatment of intractable oronasal bleeding.

Background: Factors other than efficacy and safety could influence the survival of biologics in patients with psoriasis. Little is known about whether different disease groups affect drug survival of biologics or not. Objective: This study aimed to investigate whether the availability of alternative biologics and disease groups could influence drug survival of biologics approved for psoriasis and psoriasis arthritis (PsA). Methods: A nationwide population-based retrospective cohort study was conducted using the Health Insurance and Review Assessment data in Korea between January 2009 and August 2019. Results: The drug survival analysis included 5,634 biologic episodes. Ustekinumab was the most frequently prescribed drug (n=2,488, 44.2%). Multivariable time-dependent Cox regression analysis showed that higher age, female sex, no comorbidity, concomitant cyclosporine or acitretin use, biologic-experienced and use of tumor necrosis factor (TNF)-α inhibitors were predictors of drug discontinuation. PsA was a predictor of drug persistence, particularly for TNF-α inhibitors. Ustekinumab and adalimumab discontinuation significantly increased after introducing secukinumab and ustekinumab, respectively. Conclusion The availability of alternative biologics and disease groups affect biologic drug survival in patients with psoriasis and PsA.

Background: With accumulating evidence that achieving a 90% improvement in the Psoriasis Area and Severity Index score (PASI90) has better correlation with improved healthrelated quality of life as compared to PASI75 achievement, there has been demand for establishing new treatment goals for psoriasis. Objective: We investigated whether the short-term PASI90 achievement would predict longer drug survival as compared to PASI75 achievement. Methods: This single-center retrospective cohort study reviewed 180 treatment series in 128 patients with plaque psoriasis, who were treated with tumor necrosis factor-alpha inhibitors (n=12), ustekinumab (n=88), secukinumab (n=23), guselkumab (n=45), and ixekizumab (n=12). The first effectiveness assessment, usually performed within 12 to 20 weeks, was considered a short-term treatment response to biologics. Results: After adjustment for covariates, time-dependent Cox proportional hazards regression analysis showed that moderate responders (short-term achievement of ≥PASI75 but Conclusion The short-term PASI90 achievement is a better predictor of longer drug survival as compared to PASI75 achievement.

Background: Misclassification of study designs of journals can hinder the readers from assessing the strengths and weaknesses of the study and evaluating the applicability of the study in the real-world setting. However, it seems that it is common for authors to neglect to classify the study design. Objective: We aimed to evaluate the accuracy of the classification of study designs and examine the common errors. Methods: This descriptive study analyzed four Asian dermatology journals listed in the science citation index expanded from January 2018 to December 2018. We investigated discrepancies between author-reported and actual study designs.Design Algorithm for Medical Literature on Intervention (DAMI) was used to determine the actual study design. Results: Of the 177 papers analyzed, only 72 articles (40.7%) revealed their study design and among them, 23 articles (32.0%) showed discrepancies between the author-reported and the actual study designs. Case-control studies were the most commonly misclassified study designs by authors. Conclusion There were considerable differences between the author-reported study design and the actual study design in Asian dermatology journals. Proper classification of study designs by the authors is essential to strengthen evidencebased medicine.