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Pediatric Atopic Dermatitis: Insights into Recent Clinical Advances and Treatment Strategies By Dr Swetha Mora M.B.B.S,M.S(Ophthalmology) Introduction Atopic dermatitis (AD), commonly referred to as eczema, is a chronic, relapsing, inflammatory skin condition that primarily affects children. It is characterized by dry, itchy skin and is often associated with other atopic diseases, such as asthma and allergic rhinitis. Understanding the recent trends and advancements in the clinical examination of pediatric AD is crucial for effective diagnosis and management. Recognizing Pediatric Atopic Dermatitis Age of onset (typically <5 years) Common symptoms: Pruritus (itching) Erythema (redness) Dry, scaly skin Flexural involvement Triggers: Soaps, pollen, dust mites, stress Associated conditions: asthma, allergic rhinitis Recent Trends in Pediatric Atopic Dermatitis: Rising Prevalence and Ethnic Disparities: The global burden of pediatric AD has increased, especially in industrialized nations. According to recent epidemiological studies, non-Hispanic Black children are 14.2% more likely to develop AD compared to White children, highlighting significant ethnic disparities in prevalence and access to care. Black children and European American children have higher rates of eczema compared to Hispanic children, according to WebMD. Studies suggest that Black and Hispanic children may also experience more severe cases. Overall, the prevalence of atopic dermatitis in affluent nations is estimated to be 15-20% among children, according to Fortune Journals.  Role of Genetics and Environment  Genetic predispositions, such as mutations in the filaggrin gene, compromise the skin barrier, making it more susceptible to allergens and irritants. Urban living, climate change, and pollution exacerbate the onset and severity of diseases (Elsevier). Influence of the Microbiome  Emerging research highlights the significance of the skin and gut microbiomes in the pathogenesis of atopic dermatitis (AD). Dysbiosis—an imbalance in microbial communities—can drive inflammation and immune dysregulation, a key factor in pediatric atopic dermatitis (AD). The gut and skin microbes are interconnected and influence each other. The gut microbiome produces metabolites that can affect skin health, while the skin microbiome can also impact the gut’s immune function. Understanding the role of the microbiome in Atopic disease (AD) opens up possibilities for novel therapeutic approaches. Modulating the microbiome through probiotics, dietary modifications, or targeted antibiotic therapies may help manage AD symptoms.  Digital Tools and Teledermatology  Smartphone apps and teledermatology platforms now assist in remote monitoring, symptom tracking, and even AI-based assessments, improving care in underserved and rural populations. Advances in Clinical Examination of Atopic Dermatitis (AD) **Updated Diagnostic Criteria**   The Hanifin and Rajka criteria serve as the foundational framework for diagnosing atopic dermatitis (AD). However, in primary care settings, simplified diagnostic versions are frequently utilized. Core features essential for diagnosis include:   – Chronic pruritus (itchiness)   – Distinctive lesion morphology, particularly flexural involvement in older children   – Early onset of symptoms   – A personal or family history of atopy **Severity Scoring Systems**   To facilitate standardized assessments of the disease, several scoring tools have been developed, including:   – **SCORAD (Scoring Atopic Dermatitis)**   – **EASI (Eczema Area and Severity Index)**   – **POEM (Patient-Oriented Eczema Measure)**   These tools are utilized in both clinical practice and research environments. For instance, SCORAD evaluates the extent of lesions, their severity, and subjective experiences such as itch and sleep disturbances. **Non-Invasive Diagnostic Innovations**   Recent advancements have led to the development of non-invasive diagnostic tools, including:   Dermoscopy: which allows for detailed visualization of skin structures   Transepidermal Water Loss (TEWL)devices: used to assess skin barrier functionality   Hyperspectral imaging: which aids in evaluating inflammation and monitoring healing progress   Comorbidity Screening:  Given the frequent coexistence of AD with other allergic conditions, current guidelines emphasize the importance of early screening for associated issues such as asthma, allergic rhinitis, and food allergies, particularly in patients presenting with moderate to severe cases of AD. Advances in Pediatric Atopic Dermatitis Treatment Significant progress has been made in treating pediatric atopic dermatitis (AD), particularly for moderate to severe cases. These new therapies are helping reduce flares, control inflammation, and improve quality of life with greater precision and fewer side effects. Advancements in Treating Pediatric Atopic Dermatitis Recent improvements have enhanced the treatment of pediatric atopic dermatitis (AD), particularly for moderate to severe cases. New options include topical creams, oral medications, and biologics that target specific parts of the immune system. While topical corticosteroids and calcineurin inhibitors are still used, newer non-steroidal treatments offer alternatives with fewer side effects. Systemic treatments provide better options for children who don’t respond to standard therapies. Understanding skin function and immune responses has led to personalized care that reduces flare-ups and improves overall well-being. Many children now experience fewer symptoms and healthier skin, allowing them to enjoy daily activities more fully. Biologic Therapies: Precision in Inflammation Control 🔹 Dupilumab (Dupixent®) Target: IL-4 and IL-13 pathways Approved for: Children ≥6 months Impact: Reduces itch, improves sleep and skin barrier function Note: Now approved irrespective of comorbid conditions like asthma (SpringerLink) 🔹Nemolizumab (Nemluvio®) Target: IL-31 receptor A (primary pruritus mediator) Approved for: Children ≥12 years (FDA 2024) Key Benefit: Rapid and sustained itch relief (Wikipedia) 🔹Ebglyss® (Lebrikizumab) Target: IL-13 Frequency: Monthly dosing Approved for: Adolescents ≥12 years Strength: Option for patients needing less frequent injections (Reuters) 🧴 2. Advanced Topical Therapies: Beyond Steroids 🔹 Roflumilast 0.05% (Zoryve®) Class: PDE4 inhibitor Use: Children 2–5 years Efficacy: Achieves EASI-75 in up to 40% by Week 4 Longevity: Sustained results through 56 weeks (Arcutis) 🔹Tapinarof 1% (Vtama®) Class: AhR agonist Steroid-free alternative with anti-inflammatory and antioxidant effects Approved for: Children ≥2 years (National Eczema Association) 💊 3. Oral JAK Inhibitors: Systemic Precision 🔹Baricitinib (Olumiant®) Mechanism: JAK1/JAK2 inhibitor Use: Understudy for adolescents Benefit: Long-term symptom control with minimal steroid reliance (EMJ Dermatology) 🧴 4. Barrier Repair and Proactive Skincare Ceramide-rich moisturizers: Restore the lipid barrier Proactive maintenance: Long-term control by continuing topical anti-inflammatories during remission Early TCS use in infants: May reduce future flare severity and allergic sensitization .        Emerging Treatment, Future Directions, and Research Frontiers : Personalized Medicine: Genomic and proteomic tools are being developed to tailor treatment based on the individual’s immune profile. Biomarkers: Cytokine profiling (e.g., IL-4, IL-13 levels) may guide the use of targeted therapies. Microbiome Modulation: Research

Can weight loss do more than drop the numbers on the scale? Absolutely. It might just save your heart Written By: Dr Nandini L The Hidden Cost of Weight Gain: What It Does to Your Heart Weight gain isn’t just about appearance. It sets off a cascade of dangerous changes inside your body: Increases blood pressure Triggers type 2 diabetes Disrupts lipid metabolism This causes the heart’s left ventricle to enlarge and weaken This condition, known as cardiac remodeling, reduces your heart’s ability to pump effectively and raises your risk for heart failure. Weight Loss = Cardiac Repair? New evidence shows that losing weight can reverse some of these harmful heart changes. “Lifestyle-mediated weight loss improves cardiac risk factors like diabetes and dyslipidemia,” says Dr. Ian Neeland, a cardiovascular expert. However, large trials like Look AHEAD didn’t find a direct reduction in heart attacks or strokes from lifestyle changes alone. Lifestyle: Necessary but Not Always Enough While exercise and diet are foundational, experts admit it’s tough to maintain meaningful weight loss in today’s world. “It’s difficult to get someone with morbid obesity to a healthy weight and keep them there,” says Dr. Catherine Benziger. That’s where advanced options come in. Bariatric Surgery: The Trusted Classic Surgery is now recommended for more people than ever: BMI ≥ 35 with health risks Even a BMI of 30-34.9 if nonsurgical options fail Proven benefits: Long-term sustained weight loss Blood pressure normalization Diabetes remission Reduced heart failure risk Study Highlights: GATEWAY trial: 47% hypertension remission post-surgery 42% lower risk of major cardiac events in a Canadian study GLP-1 Medications: The Game-Changing Contender GLP-1 receptor agonists (like semaglutide and tripeptide) are showing impressive results: FDA-approved to reduce the risk of heart attack and stroke Improve exercise tolerance, weight, and inflammation Key Trials: SELECT Trial: 17,604 patients, semaglutide cut major cardiac events significantly SUMMIT Trial: Tirzepatide improved heart failure symptoms and reduced the risk  Which Wins: Surgery or Medication? It depends on the patient. Surgery: May offer more sustainable, long-term benefits GLP-1s: Less invasive but costly, and may need lifelong use “The best treatment is the one the patient can sustain, and that won’t cause harm,” says Dr. Neeland. Cost and access are significant barriers to both treatments. Insurance often doesn’t cover them, and delays are common. Don’t Ditch the Basics: Lifestyle Still Matters Exercise and a heart-healthy diet are crucial, even with medical or surgical options. Eat more whole foods and fewer processed snacks Aim for 150+ minutes of aerobic exercise weekly “Once weight comes off, movement becomes easier, and healthy habits become more realistic,” says Dr. Benziger. Final Takeaway: Your Heart Deserves More Than Hope If lifestyle changes aren’t enough, don’t give up. Whether bariatric surgery or breakthrough GLP-1 therapy, science offers new paths to a healthier heart and a longer life. Talk to your healthcare provider to determine which strategy is best for you. Stay informed. Stay healthy. Your heart depends on it. Are you a USMLE aspirant? You are in the right place.. Check here https://mdresearch.us/landing-page/

Which LOR Will Strengthen Your Match More: Research or Observership? Written By: Dr Nandini L As an IMG or USMLE aspirant, you know Letters of Recommendation (LORs) are critical. But here’s a tricky question: Should you invest your limited time in a research project or observership to secure the most impactful LOR? Let’s examine the difference and, based on real NRMP data, what program directors (PDs) prefer. What’s the Core Difference Between a Research LOR and an Observership LOR? An observership LOR results from shadowing a physician. It shows exposure to U.S. clinical settings but not involvement. A research LOR, especially from a U.S.-based physician, is based on your active contribution: literature review, data analysis, writing, and more. Program directors know the difference between passive observation and intellectual engagement. Which LOR Demonstrates You’re Residency-Ready? According to the 2023 NRMP Program Director Survey: Letters of Recommendation were rated the #2 most important factor for interview selection across specialties. For IMGs, research experience—especially with publications and U.S.-based mentors—was ranked much higher than shadowing. Why? Because research proves: Critical thinking Medical writing Teamwork with U.S. professionals Initiative and long-term commitment In contrast, observership LORs often describe soft skills—“enthusiastic,” “punctual,” but not impactful. Can a Research LOR Improve My Match Odds? Yes. Especially in competitive specialties, research experience, and authentic LORs are tie-breakers. Here’s what the NRMP data shows: In Internal Medicine, 64% of matched IMGs had research experience. In Neurology, 73% of matched applicants had at least one publication. For competitive specialties like Dermatology or Radiology, 100% of matched candidates had multiple publications and U.S.-based LORs. A research-based LOR gives you something observerships can’t: proof you added value to academic medicine. What’s the Ideal Strategy to Secure a Strong Research LOR? Join a structured research program where: You work with U.S. physicians You gain hands-on research experience (case reports, abstracts, literature reviews) You receive a certified LOR based on real contributions Get a U.S.-Based Research LOR That Counts Want to boost your match chances with a recognized research LOR? Join the MD Research Program today: Earn a Certificate in Clinical Research Collaborate with top U.S. mentors Receive a strong LOR that shows your real value, not just shadowing [Click here to apply now] and build a residency-winning profile.https://mdresearch.us/landing-page/

How to Apply for US Residency: A Guide for USMLE Aspirants and IMGs Written By: Dr Nandini L Applying for a US medical residency can feel overwhelming, especially for USMLE aspirants and International Medical Graduates (IMGs). Let’s break down the process, highlight the role of research, and cover the essentials like LORs (Letters of Recommendation) and the Match. Understanding the US Residency Application Process The main pathway into US residency is the National Resident Matching Program (NRMP), commonly called “the Match.” This system pairs applicants (US graduates and IMGs) with residency programs based on mutual preferences. The process involves several steps: Completing your medical degree from an accredited institution. Passing the USMLE Step 1 and Step 2 exams. Applying to programs via the Electronic Residency Application Service (ERAS). Submitting Letters of Recommendation (LORs), a personal statement, and other required documents. Attending interviews if selected. Ranking your preferred programs and participating in the Match algorithm. Why Research Matters for USMLE Aspirants and IMGs Research is increasingly essential for residency applications, especially in competitive specialties and university-based programs. Here’s why: About 41% of program directors consider research involvement when offering interviews, and nearly 30% factor it into their rank list decisions. Research demonstrates your commitment to medicine, ability to contribute to the field, and willingness to surpass the minimum requirements. Publications, poster presentations, and research projects can help IMGs stand out, especially if clinical experience in the US is limited. Real-life Example: Imagine two IMGs with similar USMLE scores. The one with research publications and conference presentations is likelier to get an interview, especially from academic programs that value scholarly activity. Key Components of a Strong Residency Application USMLE Scores: High scores open more doors, but are not the only factor. Research: A small project or case report can enhance your profile, especially if you aim for competitive specialties or university hospitals. Letters of Recommendation (LORs): Strong LORs from US physicians or faculty who know your work well are crucial. These should speak to your clinical skills, work ethic, and character. Personal Statement: Tell your story about how you chose your specialty, what motivates you, and what you bring to the table. Clinical Experience: US clinical rotations (if possible) help you get LORs and understand the US healthcare system. Interview Performance: Be prepared to discuss your experiences, research, and motivations. Actionable Steps for USMLE Aspirants and IMGs Start Early: Begin preparing for the USMLE exams and researching potential programs at least 1-2 years before you plan to apply. Engage in Research: Seek out research opportunities, even remotely. Aim for publications, posters, or case reports. Network: Connect with mentors, attend conferences, and reach out to alums who have matched. Secure LORs: Build relationships with faculty and supervisors who can write strong, personalized recommendations. Stay Organized: Track deadlines for ERAS, USMLE, and NRMP. Missing a deadline can jeopardize your application. Apply Broadly: Especially for IMGs, applying to a wide range of programs increases your chances of matching. Final Thoughts The US residency application process is competitive. However, with strong USMLE scores, solid research experience, compelling LORs, and a well-crafted personal statement, USMLE aspirants and IMGs can maximize their chances in the Match. Remember, research isn’t just a checkbox; it’s a way to show dedication and stand out in a crowded field. If you’re starting, focus on building your profile step by step. Every publication, connection, and bit of clinical experience counts! Keywords: USMLE Aspirants, Match, Research, LOR, IMGs https://www.uscis.gov/green-card/how-to-apply-for-a-green-card https://www.youtube.com/watch?v=xEqwoS5CGpU https://usmlestrike.com/residency-match-program/

Can Probiotics potentially prevent or treat food allergies in Children? Written By: Dr.Neha Bahri Food allergies in the Pediatric population The incidence of food allergies among the pediatric population has been surging globally in the last few decades. Data shows almost 8% of children below the age of 5 in the USA have food allergies. A meta-analysis conducted from worldwide studies showed significant variation, with the prevalence of food allergies ranging between 3-and 35% in the overall population. Can it be attributed to genetics, lesser environmental allergen exposure, late introduction of common food allergens in the early years of life, or a combination of all the above factors? – is a question that remains deprived of a definitive answer. Food allergy OR Food intolerance? Food allergy is an unwanted reaction of one’s immune system to something ingested orally – food protein specifically. The reaction can be mild in the form of hives, nausea/vomiting, or severe and even life-threatening in some cases, manifesting as throat tightness, facial swelling, trouble breathing/wheezing, and/or low blood pressure, eventually leading to circulatory failure and death. Henceforth, there is a need to pay attention to the causes and potential preventive and treatment modalities for food allergies in children. Although food allergies can develop to any food, some of the most commonly implicated food allergens are Peanuts, tree nuts, Shellfish, Fish, Soy, Wheat, Diary protein, Eggs, and Sesame—the first four cause severe allergic reactions in most cases. It’s important not to confuse food allergy with food intolerance. The latter is milderand caused by digestive issues without the immune system’s involvement. Therefore, allergy testing is recommended to confirm the diagnosis of food allergy. What is the current available therapy for food allergy? There isn’t any cure for food allergy. For decades, the go-to advice was to avoid the allergen.In case of accidental exposure, Oral antihistamines, and Epinephrine Inj are recommended depending on the severity of the allergic reaction. However, is it practical? Imagine the life of a child with a food allergy not being able to eat out, be it at a restaurant, a birthday party, or a picnic, without worrying about getting an allergic reaction, which could be life-threatening. Counting how many food items are labeled as May Contain these days is impossible. The only way to avoid a food allergen is to isolate a child socially and always provide home-cooked food with known ingredients. Nonetheless, it is easier said than done. Food allergies affect the quality of life on a mental,social, and emotional level for both parents and Children. Evolving current therapiesfor food allergies include Oral immunotherapy (OIT), which is desensitizing an individual’s immune system to a food allergen by giving it orally in fractional amounts initially and then gradually increasing the dose until the individual stops reacting to a certain amount of the allergen.Oral food challenges may be given during the therapy to see how much allergen a person can tolerate without having an allergic reaction.OIT isn’t a mainstream practice and involves some risk of life-threatening reactions occurring during OIT. The inconvenience of daily dosing remains another hurdle, and the exact duration of treatment and whether an individual will remain desensitized to the food allergen after stopping OIT needs further research and studies. The first oral immunotherapy drug, Peanut Allergen Powder (Palforzia), has also been approved to treat children ages 4 to 17 with a confirmed peanut allergy. The U.S. Food and Drug Administration (FDA) recently approved omalizumab (Xolair) to help reduce allergic reactions to multiple foods in certain adults and children 1 year old or older. Omalizumab is a monoclonal antibody that is given as an injection. Therefore, it prevents an allergic reaction in case of accidental exposure to the food allergen as long as the patient is on it. The implausible cost of these drugs is only one barrier to providing a sustainable long-term benefit with improved quality of life for patients with food allergies.   What are Probiotics, and how can they help with food allergies? Simply put, Probiotics are friendly live microorganisms.Since they are friendly, they benefit us by co-residing with other beneficial microorganisms in our body and fighting off the non-friendly microorganisms that cause infections.They can be taken as an oral supplement or topical product where normal microbiomes reside in our body, such as the nose and genitals. Probiotics can stimulate primarily the innate immune system, thereby improving one’s defenses and supporting a balance between pro- and anti-inflammatory cytokines, which is our body’s messenger system. This decreases allergic inflammation and promotes epithelial integrity and permeability in the intestines. Many studies have shown that gut microflora and probiotic intake can support immune system maturity during the early years of life due to different physiological and metabolic reactions in the host. Lactobacillus and Bifidobacterium genera have shown the most encouraging results. As we advance, can probiotics be a potential savior in the Pediatric population with Food allergies? Promising results have been observed in studies with the use of probiotics in pregnancy as well as early years of life in preventing Atopic Dermatitis- a recurrent and chronic skin condition causing rashes and itching believed to be due to the ineffective skin barrier and dysregulated local and systemic immune responses. A Meta-analysis of 9 trials involving a Pediatric population with cow milk allergy (CMA) showed moderate certainty in improving CMA symptoms. However, individual factors such as age, immune status, and gut microbiomebefore initiating probiotics must be taken into account before anticipated benefits are expected. Last but not least, further studies and evidence remain pivotal in establishing the beneficial role of probiotics in food allergies.  References: Food allergies in children and babies. (2025, March 20). Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/food-allergies-in-children#:~:text=Peanuts%2C%20tree%20nuts%2C%20fish%20and,5%20years%20have%20food%20allergies. Wong G. W. (2024). Food allergies around the world. Frontiers in nutrition, 11, 1373110. https://doi.org/10.3389/fnut.2024.1373110 Food allergy – Symptoms and causes. (n.d.). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/food-allergy/symptoms-causes/syc-20355095 Food allergy – Diagnosis and treatment – Mayo Clinic. (n.d.). https://www.mayoclinic.org/diseases-conditions/food-allergy/diagnosis-treatment/drc-20355101 Professional, C. C. M. (2025, May 9). Probiotics. Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/14598-probiotics Lopez-Santamarina, A., Gonzalez, E. G., Lamas, A., Mondragon, A. D. C., Regal, P., & Miranda,

Modern Medicine Meets Women’s Health: The New Era of Fibroid Management Written By: Dr. Aida Feda Vanderpuye,MD,MPH Candidate Meet Elizabeth, G0 P0, a middle-aged White woman who had struggled with heavy vaginal bleeding and pelvic pain secondary to uterine fibroids. Like many women, her initial consultations led to discussions about hysterectomy as a first-line treatment to return to optimal health. The news left her emotionally gutted, as she did not feel comfortable losing her uterus. She was eager to explore alternative options. Was there another option? She discovered MRI-guided focused ultrasound (MRgFUS), a cutting-edge non-invasive procedure. After one outpatient procedure, she experienced significant relief from her symptoms and returned to her normal activities without the need for invasive surgery. Her story reflects the value of patient counselling and shared decision-making and the availability of less invasive treatment options for uterine fibroids. Uterine fibroids occur in about 25% of women in their reproductive age and more than 40% of women after menopause. Studies show that over 60% of African American women and nearly 40% of White women have fibroids by age 35. Fibroids are known to be the most common indication for hysterectomy. Clinicians manage asymptomatic uterine fibroids conservatively, whereas symptomatic uterine fibroids are an indication for treatment. A national survey of 968 affected women between 29 and 59 years with fibroids conducted in the USA and published by the American Journal of Obstetrics and Gynecology revealed that 79% expressed a desire to avoid invasive surgery or long recoveries, and more than half reported a preference for uterine preservation, regardless of future fertility. Current treatment: Minimally invasive alternatives to hysterectomy exist. They include Uterine Artery Embolization (UAE), Magnetic Resonance-Guided Focused Ultrasound Surgery (MRgFUS), and MR-guided High-Intensity Focused Ultrasound (MR-HIFU) Radiofrequency Ablation. According to ACOG guidelines (2022), office hysteroscopy is an outpatient procedure performed on an outpatient basis. It is a simple and cost-effective treatment modality for optimizing the care of patients with submucosal uterine fibroids. Hysteroscopy is considered a safe procedure and has the advantage of diagnosing and treating these fibroids with a single minimally invasive procedure in women who present with abnormal uterine bleeding. Recovery is quicker, and complications (such as intrauterine scarring, infections, and injury to adjacent structures) occur in less than 1% of cases. Endometrial ablation is used to manage abnormal uterine bleeding. It entails permanent destruction of the endometrial lining. It reduces the bleeding and, in some cases, stops it altogether. However, it is not used for bulk symptoms caused by large fibroids and is also not suitable for candidates seeking to preserve their fertility. There are various types, such as radiofrequency energy, heated balloon (balloon therapy), microwave energy, cryoablation, heated fluid(hydrothermal), and electrosurgery with a roller-ball-tipped microscope.  Uterine Artery Embolization blocks the blood supply to fibroids, causing shrinkage, reducing bleeding, and preserving the uterus. According to ACOG (2020), about 3 in 4 women who had UAE got relief from fibroid symptoms, and about 1 in 5 women who had UAE later needed another surgery for their fibroids (including a second UAE, myomectomy, or hysterectomy). Also, greater than 85% of patients would recommend the procedure to a friend or family member, which speaks for itself. Some of its disadvantages are complications like post-embolization syndrome, ovarian failure, and reduced fertility. The non-invasive MR-guided focused ultrasound ablation has been available to women in the U.S. It was approved by the Food and Drug Administration (FDA) in 2004. It uses MRI to guide ultrasound waves that target fibroid tissue. Recovery is speedy, and patients can return to daily work and lifestyle the next day. It preserves fertility, and many achieve successful pregnancies.  HIFU is a safe, non-invasive, and highly effective standard treatment with a broad indication range for fibroids of varying sizes. It involves delivering concentrated ultrasound energy to induce thermal coagulation and necrosis of fibroid tissue—research into HIFU dates back to the early 1900s, with significant breakthroughs in recent decades. While the treatment has high efficacy and minimal complications, it is time-intensive and limited by availability at specialized centers. Despite these limitations, HIFU remains a promising option for preserving fertility and avoiding invasive surgery. Radiofrequency ablation is a safe, versatile, and minimally invasive outpatient procedure that involves the thermal destruction of fibroids through radiofrequency. It is done through the cervix (Sonata) or laparoscopically (Acessa) and is ideal for small fibroids. RFA is used for small intramural fibroids. It preserves the uterus, and recovery time is short. Unlike myomectomy, techniques like Sonata do not involve entering the myometrium, which may protect uterine integrity. However, there is limited data on fertility outcomes following RFA. For many women, the emotional and psychological weight of undergoing hysterectomy is profound. The potential loss of fertility triggers deep feelings of depression and a sense of loss. It also underscores the importance of offering fertility-preserving or uterus-sparing alternatives. These options empower women to make informed decisions that honor their reproductive goals and personal values without undergoing invasive surgery or sacrificing their future fertility.  With increasing awareness and technological leaps, women like Elizabeth are embracing their autonomy and exploring alternatives to hysterectomy. The evolving standard of care in fibroid management must prioritize clinical outcomes and the voices and values of the women most affected. References  Orlando, Megan S. MD; Bradley, Linda D. MD. Implementation of Office Hysteroscopy for the Evaluation and Treatment of Intrauterine Pathology. Obstetrics &Gynecology 140(3):p 499-513, September 2022. | DOI: 10.1097/AOG.0000000000004898  Inbar Y, Rabinovici J, Sverdlove R, Ziv-Baran T, Machtinger R. Long-term outcomes and re-intervention rates in women undergoing mri-guided focused ultrasound (mrgfus) for uterine fibroids: a 7-year follow-up study. J Assist Reprod Genet. 2025 Apr;42(4):1191-1196. doi: 10.1007/s10815-025-03405-9. Epub 2025 Feb 3. PMID: 39899259; PMCID: PMC12055703. Vo NJ, Andrews RT. Uterine artery embolization: a safe and effective, minimally invasive, uterine-sparing treatment option for symptomatic fibroids. Semin InterventRadiol. 2008 Sep;25(3):252-60. Doi: 10.1055/s-0028-1085923. PMID: 21326515; PMCID: PMC3036449. Mahmoud MZ, Alkhorayef M, Alzimami KS, Aljuhani MS, Sulieman A. High-Intensity Focused Ultrasound (HIFU) in Uterine Fibroid Treatment: Review Study. Pol J Radiol. 2014 Oct 30; 79:384-90. Doi: 10.12659/PJR.891110.

Should I burn that excess fat or freeze it? Written By: Dr Pragya Pandey Obesity and the weight loss market With global obesity rates rising, the demand for weight loss products and services has increased. The weight management industry was worth USD 232.4 billion in 2023 and is anticipated to show an 8.6% compound annual growth rate from 2024 to 2032. The weight loss market can be broadly categorized into supplements, prescription medicines, noninvasive procedures, and surgical procedures. Unlike traditional Liposuction or other surgical procedures, supplements, medications, and noninvasive fat reduction techniques are gaining popularity because of convenience and cost 1,2. Types of fat (Visceral, subcutaneous) Visceral fat is beneath the abdominal muscles and cushions the internal organs, such as the liver, pancreas, and intestines. High visceral fat level is strongly linked with insulin resistance and associated pathologies 3. Subcutaneous fat lies underneath the skin and is distributed throughout the body. While this kind of fat is less metabolically active and provides insulation and energy storage, excessive amounts can lead to aesthetic dissatisfaction and even health risks 3. What are ‘fat burners’? ‘Fat burners’ are topical and consumable supplements that claim to promote fat metabolism. Some popular fat burners include caffeine, carnitine, green tea, conjugated linoleic acid, forskolin, chromium, kelp, and fucoxanthin. While the role of topical fat burners is limited to subcutaneous fat metabolism, evidence suggests that consumable fat burners increase overall fat metabolism. However, the benefit of adding thermogenic dietary supplements appears to be limited in reducing body mass index and improving cardiometabolic health for overweight individuals 4, 5. How does ‘fat freezing’ work? ‘Fat freezing’ or Cryolipolysis uses controlled cold temperatures for targeted destruction of subcutaneous fat cells. Since Lipid-rich tissues are more susceptible to cold injury than water-rich tissues, the skin and other surrounding structures remain safe during the procedure. This is one of the most popular nonsurgical subcutaneous fat reduction treatments, with over 450,000 procedures performed worldwide. Various Cryolipolytic devices such as CoolSculpt, CoolContour, Zeltiq, CoolTech, and Pleasanton are FDA approved for subcutaneous fat reduction from the flanks, thighs, and abdominal region 6, 7, 8.  Is it safe? While Cryolipolysis is considered a low-risk procedure, some minor and self-limited adverse events include bruising, swelling, redness, pain or discomfort, and skin discoloration. Cold burn, which was considered to be an unlikely complication, has also been reported recently. Certain contraindications for the procedure are cold-sensitive, severe varicose veins, dermatitis, and a history of hernias. One of the most distressing and common adverse effects of Cryolipolysis is paradoxical adipose hyperplasia (PAH), where the treated area paradoxically grows larger instead of shrinking. This condition typically develops two to five months after Cryolipolysis and may need surgical alleviation. A higher incidence of PAH is observed among men, Hispanics, treatment of the abdominal region, and the use of larger handpieces 7, 8. Has Cryolipolysis replaced Liposuction? Though Cryolipolysis is a nonsurgical option for targeted fat reduction, Liposuction remains a preferred choice for larger volumes of fat removal, more significant body contouring, and faster turnaround time. However, Liposuction, being invasive, comes with a longer recovery time and the potential for more complications 9. Do we still need bariatric surgeries? Bariatric surgeries are weight-loss procedures for individuals with significant obesity. The goal of such procedures is to aid in shedding overall weight and treat obesity-related conditions. Fat freezing and Liposuction are aesthetic procedures that don’t target overall weight or underlying health issues 10. So, burn or freeze the excess fat? The choice between burning or freezing excess fat depends on the individual and their goals. The old-school way of burning fat, through diet and exercise, is a holistic approach that can lead to overall weight loss and improved health. Fat freezing, an FDA-approved noninvasive procedure for localized subcutaneous fat reduction, has more of a cosmetic role for targeting specific stubborn subcutaneous fat that doesn’t respond to traditional methods. While consumable “fat burners” are often promoted for weight loss, including visceral fat, the most effective strategies for reducing visceral fat involve a combination of lifestyle changes, including diet, exercise, and stress management, rather than relying solely on supplements.    References Global Market Insight. Weight Loss and Obesity Management Market [Internet]; 2024May. Available from: https://www.gminsights.com/industry-analysis/weight-loss-and-obesity-management-market[cited 2025 May 07] Obesity and Overweight [Internet]. Geneva: World Health Organization; March 2024. Available from: URL https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight [cited2025 May 07]. Ibrahim MM. Subcutaneous and visceral adipose tissue: structural and functional differences. Obesity reviews. 2010 Jan;11(1):11-8. Clark JE, Welch S. Comparing effectiveness of fat burners and thermogenic supplements to diet and exercise for weight loss and cardiometabolic health: Systematic review and meta-analysis. Nutrition and health. 2021 Dec;27(4):445-59. Escalante G, Bryan P, Rodriguez J. Effects of a topical lotion containing aminophylline, caffeine, yohimbe, l‐carnitine, and gotu kola on thigh circumference, skinfold thickness, and fat mass in sedentary females. Journal of cosmetic dermatology. 2019 Aug;18(4):1037-43. American Society of Plastic Surgeons. Nonsurgical fat reduction [Internet];Available from: https://www.plasticsurgery.org/cosmetic-procedures/nonsurgical-fat-reduction/cryolipolysis#:~:text=Cryolipolysis%2C%20commonly%20referred%20to%20as,structures%20are%20spared%20from%20injury.[cited2025 May 07]. Kania B, Goldberg DJ. Cryolipolysis: A promising nonsurgical technique for localized fat reduction. Journal of Cosmetic Dermatology. 2023 Nov;22:1-7. Krueger N, Mai SV, Luebberding S, Sadick NS. Cryolipolysis for noninvasive body contouring: clinical efficacy and patient satisfaction. Clinical, Cosmetic and Investigational Dermatology. 2014 Jun 26:201-5. Ingargiola MJ, Motakef S, Chung MT, Vasconez HC, Sasaki GH. Cryolipolysis for fat reduction and body contouring: safety and efficacy of current treatment paradigms. Plastic and reconstructive surgery. 2015 Jun 1;135(6):1581-90. Angrisani L, Santonicola A, Iovino P, Formisano G, Buchwald H, Scopinaro N. Bariatric surgery worldwide 2013. Obesity surgery. 2015 Oct;25:1822-32.

Can Immunosuppressants Prevent PAH in Systemic Sclerosis? A New Study Investigates Written By: Dr. Nandini MANCHESTER, England — A new analysis presented at the British Society for Rheumatology (BSR) 2025 Annual Meeting suggests that while early immunosuppression does not prevent the onset of pulmonary arterial hypertension (PAH) in patients with systemic sclerosis (SSc), it may improve survival in those who do develop the condition. Study Background and Key Investigators Dr. Christopher Denton, professor of experimental rheumatology at UCL Medical School and head of the Centre for Rheumatology at the Royal Free Hospital, noted that PAH in SSc is typically considered non-inflammatory. However, preliminary data indicated a potential protective effect of hydroxychloroquine in reducing PAH risk—an unexpected finding given the drug’s reputation as relatively mild in immunosuppressive action. “Hydroxychloroquine stood out. Patients on this drug seemed less likely to develop PAH,” Dr. Denton said, suggesting immunomodulation may still play a role in disease progression. PAH: A Severe SSc Complication Dr. Stefano Rodolfi, who presented the findings, emphasized that PAH remains one of the most devastating complications of SSc, affecting roughly 8–13% of patients. The 3-year survival rate remains poor, hovering around 50%. He described PAH’s pathogenesis as beginning with pulmonary vascular injury, leading to a fibroproliferative response, vascular remodeling, and, ultimately, right heart failure. Despite its vascular basis, Rodolfi highlighted mounting evidence pointing to immune dysregulation, including autoantibodies, inflammatory cytokines, and activated immune cells in affected patients. Study Design: Who Was Studied? The retrospective analysis included 629 patients with well-documented SSc. After exclusions based on significant interstitial lung disease (ILD) or low lung function, 607 patients were analyzed. Of these, 320 had received immunosuppressive therapy at some point, while 287 had not. Patients were grouped based on the timing of treatment: Early immunosuppression (within 5 years of diagnosis) – n = 206 Late immunosuppression (after 5 years) – n = 144 No immunosuppression – n = 287 Immunosuppression was defined as the sustained use of glucocorticoids, conventional DMARDs, or biologic agents. Findings: PAH Risk and Survival Outcomes Over a 21-year median follow-up, 77 patients developed PAH. Incidence by the group was: Early immunosuppression: 5.3% Late immunosuppression: 14.6% No immunosuppression: 15.7% At first glance, early treatment may reduce PAH risk. However, after adjusting for confounders (such as gender, autoantibody profile, renal involvement, and diffuse cutaneous SSc), the time to PAH onset was statistically similar across all groups (P = .581). Interestingly, when individual drugs were analyzed, mycophenolate mofetil (MMF) showed significantly lower odds of PAH (OR 0.12; P = .048). Other risk factors included: ILD (OR 3.01; P = .006) Scleroderma renal crisis (OR 6.54; P = .035) Anticentromere antibodies (OR 2.94; P = .026) Conversely, the anti–scl–70 antibody appeared protective (OR 0.15; P = .009). Survival Benefits Of Immunosuppression In a separate analysis focusing on 72 SSc-PAH patients, researchers compared those who had ever received immunosuppressants (n = 30) to those who had not (n = 42). Though baseline characteristics varied (e.g., more diffuse disease and ILD in the immunosuppressed group), the results showed: Median survival from PAH diagnosis was 7 years (treated) vs 4 years (untreated) Immunosuppression reduced mortality risk (OR 0.41; P = .045) Most striking was the impact of hydroxychloroquine. Of 9 patients on the drug, only 2 died, and both more than 17 years post-PAH diagnosis (HR 0.04; P = .004). Rodolfi noted that preclinical studies support these findings, with hydroxychloroquine demonstrating vascular protective effects and anti-remodeling properties in animal models. Clinical Implications and the Road Ahead Commenting on the findings, Dr. Carmel Stober from Cambridge University Hospitals said the study may change clinical thinking, particularly regarding hydroxychloroquine use in patients with limited cutaneous SSc, where immunosuppression is not routine. “If there’s even modest benefit and low risk, clinicians may start rethinking hydroxychloroquine’s role,” she said. Still, experts agree that randomized controlled trials are needed. A UK multicenter RCT is already underway, investigating whether MMF plus standard care can slow SSc progression compared to standard care alone. Conclusion While early immunosuppression does not appear to prevent PAH onset in systemic sclerosis, specific agents—particularly MMF and hydroxychloroquine—may offer survival benefits and delay disease progression. These findings support a more nuanced, drug-specific approach and signal the need for further prospective studies.

Patient-Centered Care: Revolutionizing Healthcare for Better Outcomes Written By: Dr. Aida Vandepuye, MD, MPH Candidate Patient-centered care (PCC) is a healthcare model that entails a holistic approach to managing patients with dignity, respect, trust, and compassion and involving them in all decisions concerning their health. It is a partnership between practitioners, patients, and their families that ensures that the patient’s needs, wants, and preferences are central to decision-making. PCC is the cornerstone of modern medicine because it shifts the focus from traditional, disease-centered models to prioritizing patients as active participants in their care. In an era of cutting-edge technology in diagnostics and treatment of medicine, PCC ensures that healthcare remains compassionate, respectful, and responsive. It fosters strong trust between provider and patient, ensures a higher patient satisfaction rate, improves outcomes, and promotes better adherence to lifestyle modifications and treatment. It is cost-effective because it minimizes unnecessary interventions and promotes efficient care.PCC empowers individuals to participate in their health journey. As healthcare systems aim for higher quality, safety, and efficiency, embracing patient-centered principles is essential for delivering clinically effective and emotionally supportive care. A built environment is the physical design of a healthcare facility. Its key elements include accessibility, privacy, comfort, aesthetics, and flexible spaces that adapt to patients’ different needs. The built environment affects patients’ experience, comfort, and dignity, emphasizing its impact on PCC. The PCC Service Delivery Framework emphasizes timely and equitable access to care, flexible appointments, and prompt responses to patients’ concerns. It supports individualized care through comprehensive evaluations and coordinated treatment plans. Trust and rapport enrich open communication and respect for preferences. Care continuity achieves seamless transitions and strong follow-up support. Empowering patients through shared decision-making and education ensures they can make informed choices and actively manage their health.  Additionally, PCC includes caregiver engagement, emotional support services, and attention to patients’ physical and environmental needs—such as pain management, healing-centered facility design, and survivorship programs—to enhance the patient experience: safety and quality maintenance protocols, incident reporting, and continuous quality improvement based on patient feedback. Finally, the hospital’s organizational culture is grounded in a commitment to patient-centered principles, supported by ongoing staff training and a mission that reflects these values. Many key organizations in the USA regulate and assess PCC. The Centers for Medicare & Medicaid Services (CMS) support healthcare quality through payment policies, quality reporting programs, and the Meaningful Measures Initiative, which emphasizes patient engagement and feedback. The Joint Commission accredits healthcare organizations and sets standards that include patient rights, communication, and shared decision-making. The Agency for Healthcare Research and Quality (AHRQ) advances PCC by funding research and providing evidence-based resources for healthcare providers. Likewise, the National Committee for Quality Assurance (NCQA) accredits healthcare organizations and develops quality measures related to PCC. Professional organizations such as the American Medical Association (AMA) and the American Nurses Association (ANA) advocate for PCC and guide their members. The National Patient Advocate Foundation and the Picker Institute promote patient rights and offer resources to patients and families. Furthermore, state licensing boards regulate communication, informed consent, and patient rights within their guidelines. Together, these bodies define, measure, and promote PCC, collaborating to continually advance its role in the US healthcare system. These institutions often collaborate and build upon each other’s work to advance PCC in the US healthcare system. PCC has become a foundational goal of healthcare reform and quality improvement in the United States. National initiatives such as the Institute of Medicine’s landmark 2001 report “Crossing the Quality Chasm” emphasized patient-centeredness as one of six core aims for a high-quality healthcare system. Organizations like the Centers for Medicare & Medicaid Services (CMS) and the Joint Commission have since integrated patient-centered principles into their standards, accreditation, and payment models. Across hospitals, clinics, and community health programs, there is an intensifying focus on respecting the autonomy of patients’ individual preferences, promoting shared decision-making, respecting the autonomy of patients’ individual preferences,improving communication, and addressing social determinants of health. PCC is pivotal for optimizing clinical outcomes, building rapport and trust, decreasing disparities, and enhancing the healthcare experience for diverse populations in a complex US healthcare system. PCC has gained attention on the global stage. The International Beryl Institute is a global community of healthcare professionals and experience champions committed to transforming the human experience in healthcare. It was established in 2010. This institution advocates PCC, and it currently involves 49 countries, emphasizing PCC’s broad and evolving influence. In conclusion, PCC marks a revolutionary change in healthcare delivery. With the support of key regulatory bodies and healthcare professionals, PCC poses to shape the future of medicine.   References Edgman-Levitan S, Schoenbaum SC. Patient-centered care: achieving higher quality by designing care through the patient’s eyes. Isr J Health Policy Res. 2021 Mar 5;10(1):21. doi: 10.1186/s13584-021-00459-9. PMID: 33673875; PMCID: PMC7934513.  More patient-centered care, better healthcare: the association between patient-centered care and healthcare outcomes in inpatientsChenhao Yu 1,†, Yun Xian 1,†, Tiantian Jing 1, Mayangzong Bai 1, Xueyuan Li 2, Jiahui Li 3, Huigang Liang 4,*, Guangjun Yu 1,5,*, Zhiruo Zhang 1,*2023 Oct 19; 11:1148277. doi: 10.3389/fpubh.2023.1148277Patient-Centered Care and Preference-Sensitive Decision MakingCarla C. Keirns, MD, MA, MS, PhD; Susan Dorr Goold, MD, MHSA, MAJAMA. 2009;302(16):1805-1806. doi:10.1001/jama.2009.15 https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://www.mayoclinic.org/patientcenteredcare&ved=2ahUKEwjdvLerw8OLAxUsg4kEHWWwCmgQFnoECBIQAQ&usg=AOvVaw06ZlDpZoeFJGNQetTjKMyi

The Role of Research in Getting a US Residency Written By: Dr. Nandini L Research experience plays a significant role in the US medical residency application process, although it is not strictly mandatory. Its impact varies by specialty, program competitiveness, and your interests and career goals.   Why Research Matters Differentiates Your Application Research experience adds depth and uniqueness to your application, especially in a highly competitive environment. It demonstrates mastery of the scientific method, critical thinking, and evidence-based practice—skills that residency programs value highly. Signals Commitment and Curiosity Engaging in research shows your dedication to advancing medical knowledge and your curiosity as a future physician. It can highlight your passion for a particular specialty or academic medicine. Develops Transferable Skills Through research, you build analytical, problem-solving, and time management skills. These are seen as proxies for qualities such as self-directed learning and commitment to the specialty.  Creates Networking and Mentorship Opportunities Working on research projects often connects you with mentors and peers, leading to strong letters of recommendation and further clinical or research opportunities.   How Residency Programs View Research Factor Importance Relative to Research USMLE Step 1 & 2 Scores are generally more important Letters of Recommendation are generally more important Clerkship Grades are usually more important Research Experience is Helpful, sometimes equally crucial in competitive specialties. Leadership, Service, and Honor Societies are often less important than research in top fields Research is often weighted more heavily in competitive specialties (e.g., dermatology, orthopedics, radiology) and may be essential to stand out. In less competitive fields, research is a bonus but not a requirement. The transition of USMLE Step 1 to a pass/fail format may increase the emphasis on research and other holistic factors in the application process.   Quality Over Quantity Programs prefer meaningful involvement in one or two quality projects rather than superficial participation in many. Dissemination of research (e.g., presentations, publications) can further strengthen your application. Is Research Required? Research is not a strict requirement for most residency programs. Many successful residents have little to no research experience, especially if they excel in other areas, such as clinical performance, leadership, or service. Pursue research if it aligns with your interests and career goals, not solely as a checkbox for your application. Actionable Steps If you enjoy research or aim for a competitive specialty, seek research opportunities early in medical school. Focus on quality projects and see them through to publication or presentation. Utilize your research experience to establish connections with mentors who can provide strong letters of recommendation. Be prepared to discuss your research during residency interviews, as it is often a topic that comes up and can help you stand out. Real-Life Example Imagine two applicants: Applicant A has strong clinical grades and no research, but has led impactful community service projects. Applicant B has average grades but has published research in their particular specialty. Both can match, but Applicant B’s research might give them an edge in a competitive specialty or academic program. At the same time, Applicant A’s leadership and service could be more valued in community-focused programs. Summary Research experience is highly valued for US residency applications, particularly in competitive specialties and academic medicine. It demonstrates crucial skills, signals commitment, and can open doors through networking. However, it is not universally required, and applicants should pursue research based on genuine interest and career alignment, rather than simply as a resume booster.   Citations: https://mdresearch.us/why-research-experience-is-your-fast-track-to-a-us-medical-residencydont-wait/ https://www.ama-assn.org/medical-students/preparing-residency/how-medical-student-research-can-resonate-residency-programs https://pmc.ncbi.nlm.nih.gov/articles/PMC10516175/ https://www.sgu.edu/blog/medical/why-pursue-research-opportunities-for-medical-students/ https://residentsmedical.com/benefits-of-research-when-trying-to-land-u-s-medical-residency/ https://www.ama-assn.org/medical-students/preparing-residency/residency-program-research-faqs-how-get-key-information https://www.reddit.com/r/medicalschool/comments/195vvbg/why_is_research_such_a_huge_thing_seeming/ https://forums.studentdoctor.net/threads/how-important-is-research-for-residency.1276039/