FDA Approved Biologics: Can Etanercept and Ustekinumab be Considered a First-Line Systemic Therapy for Pediatric/Adolescents in Moderate to Severe Psoriasis? A Systematic Review.
Aug,
2020
Psoriasis is a chronic immune-mediated skin disorder. Due to lack of clarity in its pathogenesis, a cure with existing treatment is a big challenge. Biologics, a revolutionary treatment, are potent immunomodulators that explicitly target the culprit cells of the immune system to achieve the maximum level of Psoriasis Area and Severity Index (PASI) score (75 to 90) and clear or almost clear skin in moderate to severe psoriasis. They have been a successful therapy in adult severe psoriasis for a decade. In recent years, biologics have unprecedently sought the attention of the pediatric psoriatic population by proving an efficacious and safe option. The aim of the study is to provide a systematic review of efficacy, safety, and impact on the quality of life of Food and Drug Administration (FDA)-approved biologics, namely etanercept and ustekinumab, and their use as a "first-line systemic therapy" in the moderate to severe pediatric and adolescent psoriatic population. We explored PubMed, Cochrane Library, Google Scholar, American Academy of Dermatology website, ClinicalTrials.gov, the FDA site, and the National Psoriasis Foundation USA site as major database searches. Psoriasis, pediatric, etanercept, and ustekinumab were keywords used to find the relevant literature. Clinical trials and observational studies were retrieved and analyzed to assess the efficacy and safety of FDA-approved biologics as first-line systemic therapy in pediatric psoriasis. The relevant evidence-based studies and the Joint American Academy of Dermatology-National Psoriasis Foundation (AAD-NPF) guideline have shown that etanercept and ustekinumab biologics are significantly effective and safe systemic therapies in dealing with moderate to severe psoriasis in pediatric and adolescent patients and have unprecedently improved their quality of life. Thus, they can be confidently considered as first-line systemic therapy in moderate to severe pediatric and adolescent psoriatic patients by applying the specific criteria and proper monitoring. However, health practitioners and dermatologists must educate pediatric patients and their caretakers about their adverse effects, success/failure chance, careful monitoring, and follow-up plan to achieve the desired result. Подробнее
Cureus
Surgical Margin of Excision in Basal Cell Carcinoma: A Systematic Review of Literature.
Jul,
2020
Skin cancer is one of the most common cancers in the world and consists of melanoma and non-melanoma skin cancer (NMSC). Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are the most common non-melanoma skin cancers. The ideal surgical treatment for BCC is complete removal, and it can be achieved either with safety margins or with micrographic control. The currently accepted treatment for basal cell carcinoma is an elliptical excision with a 4-mm surgical margin of clinically normal skin. However, because of cosmetic and functional constraints on the face, a 4-mm surgical margin is often not feasible. We used PubMed, PubMed Central (PMC), and Google scholar as our main databases to search for the relevant published studies and used "Basal cell carcinoma" and "narrow excision margins" as Medical Subject Headings (MeSH) keywords. Fifteen studies were finalized for the review, which included 3843 lesions. The size of the lesions ranged from 3 to 30 mm, with a mean size of 11.7 mm. Surgical margins varied from 1 to 5 mm. This review was done to evaluate if small, well-defined primary BCCs can be excised using narrow surgical margins. Based on the reviewed literature, we found that for primary well-demarcated BCCs smaller than 2 cm, in the low-risk group, a safety margin of 3 mm gives satisfactory results. In the high-risk group, and for lesions larger than 2 cm, a 4-6 mm margin is suggested for getting clear margins. Mohs micrographic surgery is advocated for more complex and recurrent lesions where the clinical margin is not apparent. However, micrographic surgery is not readily available in many places and requires more training and experience. Therefore, excision with 2 mm margins for clinically well-defined lesions with close follow-up can be followed to preserve the healthy tissue in anatomic constraint lesions and avoid the need for complex reconstructive procedures. Подробнее
Cureus
Coronavirus Disease 2019 (COVID-19) in Children: Vulnerable or Spared? A Systematic Review.
May,
2020
The ongoing pandemic of coronavirus disease 2019 (COVID-19) has affected people from all cultures, religions, gender, and age groups around the world. In the last few months, several studies have been conducted on various aspects of COVID-19. Our goal was to see if the pediatric population is vulnerable to this infection. In this review, we conducted extensive research mainly by using the PubMed database. We used Medical Subject Headings (MeSH) and associated keywords to engage in an extensive search focussing on COVID-19 in the pediatric population. We discovered that most of the studies were from China, and some of them were in the Chinese language. However, English translations of many of the studies were available. For accessing the relevant statistical data, we relied on the World Health Organization (WHO) resources and the official website of the Ontario Government (ontario.ca). Most of the studies showed that the virus has affected the pediatric population. However, we found some differences among these studies regarding the severity of symptoms in children affected by COVID-19. While a few studies stated that the virus has presented with milder symptoms in the pediatric population, some studies have presented data of children who have suffered life-threatening complications due to COVID-19. Although the data is limited, we have been able to conclude from the studies we reviewed that COVID-19 does indeed affect children the same way as any other age group. Moreover, children can act as carriers of the virus and can endanger the lives of other individuals. Besides, neonates and infants can easily acquire the infection from family members without having any exposure to the outside world. Hence, utmost care should be taken while handling this population. More trials and studies should be conducted to analyze the impact of early diagnosis of infection in children and its management. Подробнее
Cureus
