Double-Blind Placebo-Controlled Study of Memantine in Trichotillomania and Skin-Picking Disorder
This study found that memantine treatment resulted in statistically significant reductions in hair pulling and skin-picking symptoms compared with placebo, with relatively high efficacy (based on number needed to treat), and was well tolerated.
KEY FINDINGS: This study found that memantine treatment resulted in statistically significant reductions in hair pulling and skin-picking symptoms compared with placebo, with relatively high efficacy (based on number needed to treat), and was well tolerated. The glutamate system may prove to be a beneficial target in the treatment of compulsive behaviors.
BACKGROUND: Trichotillomania and skin-picking disorder are underrecognized and often disabling conditions in which individuals repeatedly pull at their hair or pick at their skin, leading to noticeable hair loss or tissue damage. To date there is a severe paucity of evidence-based treatments for these conditions. In this study, the authors sought to determine whether memantine, a glutamate modulator, is more effective than placebo in reducing hair-pulling and skin-picking behavior.
DETAILS: One hundred adults with trichotillomania or skin-picking disorder (86 women; mean age, 31.4 years [SD=10.2]) were enrolled in a double-blind trial of memantine (dosing range, 10-20 mg/day) or placebo for 8 weeks. Participants were assessed with measures of pulling and picking severity. Outcomes were examined using a linear mixed-effects model. The prespecified primary outcome measure was treatment-related change on the NIMH Trichotillomania Symptom Severity Scale, modified to include skin picking. Compared with placebo, memantine treatment was associated with significant improvements in scores on the NIMH scale, Sheehan Disability Scale, and Clinical Global Impressions severity scale in terms of treatment-by-time interactions. At study endpoint, 60.5% of participants in the memantine group were "much or very much improved," compared with 8.3% in the placebo group (number needed to treat=1.9). Adverse events did not differ significantly between the treatment arms.
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Source: Grant, J. E., Chesivoir, E., Valle, S., et al. (2023). Double-Blind Placebo-Controlled Study of Memantine in Trichotillomania and Skin-Picking Disorder. Am J Psychiatry. 2023; 180(5): 348-356. Published: May, 2023. DOI: 10.1176/appi.ajp.20220737.
Microbial Dominance in Diabetic Foot Osteomyelitis Determined With Nanopore Sequencing Techniques Predicts Positive Response to Surgical Intervention
In patients with surgically treated OM, nanopore sequencing can generate interpretable metagenomic data from bone specimens that are culture concordant and associated with clinical response. These findings support the feasibility and plausibility of using real-time metagenomic sequencing to improve the clinical management of OM.
KEY FINDINGS: In patients with surgically treated OM, nanopore sequencing can generate interpretable metagenomic data from bone specimens that are culture concordant and associated with clinical response. These findings support the feasibility and plausibility of using real-time metagenomic sequencing to improve the clinical management of OM.
BACKGROUND: Tools to predict successful response to surgery for the treatment of diabetic foot osteomyelitis (OM) are currently lacking. Recent studies in nonbone infections have revealed that nanopore sequencing can provide real-time metagenomic identification of pathogens. In a cohort of patients with diabetic foot OM, we tested the feasibility of generating interpretable metagenomic data from surgically acquired osseous tissue, comparing bacterial community features (pathogen dominance) with clinical outcomes (resolution of infection). Researchers hypothesized that nanopore-generated microbial data can be feasibly generated from surgically acquired bone, aligns with conventional culture results, and is predictive of clinical response.
DETAILS: Researchers performed a pilot feasibility study of 10 consecutive patients hospitalized with diabetic foot OM who underwent surgery for OM. We performed metagenomic sequencing of surgical bone samples using the MinION (Oxford Nanopore). The primary metagenomic index was community dominance (relative abundance of most abundant species). The primary clinical end point was the clinical response to surgery, adjudicated at 1 year. Authors successfully generated interpretable metagenomic data from all 10 specimens, including 2 with negative culture growth. Among culture-positive specimens, the culture-identified pathogen was either the first or second most abundant organism in all cases. Patients with favorable clinical response exhibited greater pathogen dominance than those with unfavorable response (P = .002).
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Copyright © The Authors. Oxford University Press for the Infectious Diseases Society of America. All rights reserved.
Source: Schmidt, B. M., Ranjan, P., Erb-Downward, J., et al. Microbial Dominance in Diabetic Foot Osteomyelitis Determined With Nanopore Sequencing Techniques Predicts Positive Response to Surgical Intervention. The Journal of Infectious Disease. 2026; 233(3): 458-464. Published: March 15, 2026. DOI: 10.1093/infdis/jiaf617
Risk of Dyslipidemia Associated With Oral Janus Kinase Inhibitors
The meta-analysis found that all four JAKi drugs examined - baricitinib, upadacitinib, tofacitinib, and decernotinib - were associated with measurable increases in both HDL and LDL cholesterol compared to placebo. Notably, LDL elevations ranged from approximately 9 to 16 mg/dL depending on the drug, raising potential cardiovascular concerns. The authors conclude that dyslipidemia is a meaningful risk associated with JAKi therapy, and recommend that clinicians conduct routine lipid monitoring and regular cardiovascular risk assessments for patients on these medications to ensure long-term safety.
Summary
A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials
[Posted 16/Mar/2026]
AUDIENCE: Dermatology, Oncology
KEY FINDINGS: This systematic review and meta-analysis highlight the risk of dyslipidemia during treatment with JAKi, which could pose cardiovascular risks. Thus, regular assessments of cardiovascular risk factors and routine lipid monitoring in patients undergoing JAKi therapy may be essential for managing dyslipidemia and evaluating long-term cardiovascular safety.
BACKGROUND: Janus kinase inhibitors (JAKi) have sparked a new era in the treatment of immune-mediated diseases. While some studies have reported an increased incidence of dyslipidemia in JAKi-treated patients, the full extent of this adverse event is not established. The study aimed to assess the association between treatment with oral JAKi and dyslipidemia in phases 2 and 3 placebo-controlled randomized clinical trials (RCTs).
DETAILS: Janus kinase inhibitors (JAKi) have sparked a new era in the treatment of immune-mediated diseases. While some studies have reported an increased incidence of dyslipidemia in JAKi-treated patients, the full extent of this adverse event is not established. The study aimed to assess the association between treatment with oral JAKi and dyslipidemia in phases 2 and 3 placebo-controlled randomized clinical trials (RCTs). A systematic review and meta-analysis were conducted, encompassing phase 2 and 3 RCTs. The Embase, PubMed, and Web of Science databases were searched up to March 9, 2025. Only RCTs reporting lipid levels before and after treatment with JAKi were included. Data were extracted for changes in high-density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol (TC), and triglycerides (TG) with values reported in mg/dL. A total of 13 studies were included in the analysis, comprising nine studies on rheumatoid arthritis, two on atopic dermatitis, one on Crohn's disease, and one on psoriasis. The studies encompassed a total of 3978 patients treated with JAKi and 1680 controls. Across all indications, the mean difference between JAKi and placebo for individual drug, was increased by 6.07 mg/dL (95% confidence interval [CI], 5.01-7.14) for HDL and 9.05 mg/dL (95% CI, 7.78-10.32) for LDL for baricitinib; HDL 5.4 mg/dL (95% CI, 3.2-7.7) and LDL 12.4 mg/dL (95% CI, 8.9-15.9) for upadacitinib; HDL 7.0 mg/dL (95% CI, 5.7-8.3) and LDL 15.7 mg/dL (95% CI, 12.9-18.6) for tofacitinib; and lastly HDL 3.0 mg/dL (95% CI, 0.2-5.8) and LDL 14.9 mg/dL (95% CI, 3.6-26.3) for decernotinib.
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Source: Isufi, D., Javanmardi, N., Jense, M. B., et al. Risk of Dyslipidemia Associated With Oral Janus Kinase Inhibitors: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials. International Journal of Dermatology. 2026; 65: 737-745. Published: March, 2026. DOI: 10.1111/ijd.70122
Efficacy and Safety of the Neuroplastogen TSND-201 for the Treatment of PTSD
In the IMPACT-1 randomized clinical trial including adults with severe PTSD, intermittent treatment with TSND-201 (4 doses, 1 week apart) was generally well tolerated, safe, and associated with statistically significant and clinically meaningful improvements in PTSD symptoms that persisted well beyond the initial dosing period. Results support the further development of TSND-201 as a potential acute, intermittent treatment for PTSD. Together, these results demonstrate that TSND-201 has the potential to be a highly efficacious, rapid-acting and durable medication for PTSD. These promising results will require replication in larger upcoming studies.
KEY FINDINGS: Results of this randomized clinical trial reveal that TSND-201 demonstrated statistically significant efficacy and was well tolerated, supporting its potential as a rapid-acting, durable treatment for PTSD.
BACKGROUND:
DETAILS: A Study to Assess the Use of Methylone in the Treatment of PTSD (IMPACT-1) part B was a phase 2, multicenter, double-blind, placebo-controlled, 10-week randomized clinical trial of TSND-201 in people with PTSD conducted between November 29, 2023, and February 19, 2025, across 16 sites in the US, UK, and Ireland. Adults aged 18 to 65 years who met DSM-5 criteria for current PTSD and 6 months or more of symptoms (Clinician-Administered PTSD Scales for DSM-5 [CAPS-5] >=35) were eligible. Participants were randomized 1:1 to receive TSND-201 or placebo. There were 4 once-weekly oral dosing sessions (150 mg followed by 100 mg or placebo). No psychotherapy was provided; however, dosing sessions were monitored by mental health professionals using a nondirective approach. Participants were followed up for 6 weeks after the last dose. The primary end point was change from baseline to day 64 in the CAPS-5 total severity score. Secondary end points included changes in PTSD Checklist for DSM-5 (PCL-5), Sheehan Disability Scale (SDS), and Montgomery-Asberg Depression Rating Scale (MADRS) scores. Other measures included response (>=50% improvement from baseline), remission (<=11 total severity score), loss of PTSD diagnosis, changes in CAPS-5 symptom clusters, and incidence of treatment-emergent adverse events (TEAEs). Safety was assessed by monitoring adverse events, vital signs, and Columbia-Suicide Severity Rating Scale. Among the 65 participants (mean [SD] age, 43.7 [10.5] years; 39 female [60.0%]), TSND-201 demonstrated significantly greater improvement in CAPS-5 total score than placebo (least-squares mean difference, 9.64; 90% CI, -16.48 to -2.80; P = .01). PCL-5 (-28.46 vs -19.47; LS mean treatment difference, -8.99; 90% CI, -17.81 to -0.17), SDS (-8.29 vs -3.57; LS mean treatment difference, -4.72; 90% CI, -8.84 to -0.61), and MADRS (-13.94 vs -7.73; LS mean treatment difference, -6.21; 90% CI, -12.41 to -0.27) scores were also improved. Common TEAEs in the TSND-201 group included headache, decreased appetite, nausea, dizziness, blood pressure increased, dry mouth, insomnia.
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Source: Jones, A., Warner-Schmidt,J., Kwak, H., et al. Efficacy and Safety of the Neuroplastogen TSND-201 for the Treatment of PTSD: A Randomized Clinical Trial. JAMA Psychiatry. 2026; Published: February 18, 2026. DOI: 10.1001/jamapsychiatry.2025.4625
Vaginal Hysterectomy vs Laparoscopic Hysterectomy for Benign Indications
Complication rates were low after vaginal hysterectomy and laparoscopic hysterectomy. The study results suggest that vaginal hysterectomy is not clearly a preferred route for hysterectomy over laparoscopic hysterectomy. The data support further investigation of the optimal surgical approach for hysterectomy with large, prospective clinical studies.
Summary
Complications and Length of Stay in a National Analysis of Contemporary Data
[Posted 3/Mar/2026]
AUDIENCE: Ob/Gyn, Oncology
KEY FINDINGS: Complication rates were low after vaginal hysterectomy and laparoscopic hysterectomy. The study results suggest that vaginal hysterectomy is not clearly a preferred route for hysterectomy over laparoscopic hysterectomy. The data support further investigation of the optimal surgical approach for hysterectomy with large, prospective clinical studies.
BACKGROUND: The current recommendation to select vaginal hysterectomy for benign indications whenever feasible is based on clinical trials with limited cohorts and older data. This study aimed to evaluate the association between the hysterectomy route (vaginal hysterectomy or laparoscopic/robotic hysterectomy) and short-term outcomes.
DETAILS: A cohort study was conducted using prospectively collected data from the American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2022. Women who underwent vaginal hysterectomy or laparoscopic hysterectomy for benign indications were included. Abdominal hysterectomies, laparoscopic/robotic supracervical hysterectomies, laparoscopic-assisted vaginal hysterectomies, and emergent surgical procedures were excluded. Propensity score matching and multivariate regression analyses were performed to assess outcomes. The primary outcome was the occurrence of complications within 30 days, which was stratified using the Clavien-Dindo classification. The secondary outcomes included operative time, overnight admission, and hospital length of stay. After propensity score matching for patients’ demographics and surgical characteristics, including uterine weight (<250 g or >250 g) and concomitant procedures performed, 83,436 women were included in the analysis, with 41,718 patients each in the vaginal hysterectomy and laparoscopic hysterectomy groups in a 1:1 ratio. Postoperative complications were low in the vaginal hysterectomy and laparoscopic hysterectomy groups (8.2% vs 6.4%, respectively; P<.001; adjusted odds ratio, 1.23 [95% confidence interval, 1.15-1.31]). Major and minor complication risks were minimally increased in the vaginal hysterectomy group. Specifically, vaginal hysterectomy was associated with higher risks of blood transfusion, urinary tract infection, organ/space infection, and reoperation, and laparoscopic hysterectomy was associated with higher risks of wound dehiscence and pulmonary embolism. Operative time was shorter in the vaginal hysterectomy group than in the laparoscopic hysterectomy group (109.6 vs 137.0 minutes, respectively; P<.001). The proportions of overnight admission were 35.5% after vaginal hysterectomy and 27.2% after laparoscopic hysterectomy (adjusted odds ratio, 2.10 [95% confidence interval, 2.02-2.18]). Hospital lengths of stay for >=1 day were 77.9% in the vaginal hysterectomy group and 77.1% in the laparoscopic hysterectomy group (adjusted odds ratio, 1.90 [95% confidence interval, 1.82-1.99]). In addition, hospital lengths of stay for >=2 days were 13.2% in the vaginal hysterectomy group and 10.1% in the laparoscopic hysterectomy group (adjusted odds ratio, 1.55 [95% confidence interval, 1.47-1.63]).
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Source: Meyer, R., Hamilton, K. M., Ezike, O., et al. Vaginal Hysterectomy vs Laparoscopic Hysterectomy for Benign Indications: Complications and Length of Stay in a National Analysis of Contemporary Data. American Journal of Obstetrics & Gynecology. 2026; 234(3): 620-631. Published: March, 2026. DOI: 10.1016/j.ajog.2025.10.027.
Long-Term Control of Human Papillomavirus-Related Focal Epithelial Hyperplasia in an Human Immunodeficiency Virus-Positive Patient Using Methylene Blue-Mediated Photodynamic Therapy
Topical MB-mediated PDT successfully managed HPV-related FEH in an immunocompromised individual with history of valve disease. This outcome supports the need for further validation through clinical trials.
KEY FINDINGS: PDT mediated by MB is an effective and affordable approach for treating FEH associated with HPV in immunosuppressed patients, offering favorable outcomes and improved quality of life.
BACKGROUND: Human papillomavirus (HPV) infections are a major cause of oral lesions, and in individuals living with HIV, lesions such as focal epithelial hyperplasia (FEH) may persist or exhibit atypical features, potentially progressing to more severe conditions if untreated. Managing oral HPV lesions in immunocompromised patients is challenging, as conventional therapies may carry higher risks or show limited efficacy.
DETAILS: This study reports the case of a 49-year-old HIV-positive male with valve disease and arthritis, requiring crutches for mobility. He presented with multiple painless oral lesions, diagnosed as FEH associated with oral HPV, and had previously undergone unsuccessful treatments. Photodynamic therapy (PDT) using methylene blue (MB) and a red laser was proposed as a treatment. Topical MB-mediated PDT successfully cleared the FEH lesions, with no recurrence observed over 24 months.
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Source: de Araújo, J. C., Paiva, H. C., Faara, P. M. M., et al. Long-Term Control of Human Papillomavirus-Related Focal Epithelial Hyperplasia in an Human Immunodeficiency Virus-Positive Patient Using Methylene Blue-Mediated Photodynamic Therapy. A Case Report. Lasers in Surgery and Medicine. 2026; 58(2): 70-73. Published: February, 2026. DOI: 10.1002/lsm.70091
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