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  • Lynparza trial stopped at colorectal cancer

    By: Maya Nguyen, Master’s in PRCC Candidate, Georgetown School for Continuing Studies.


    Lynparza is a targeted therapy for patients with advanced ovarian cancer, metastatic prostate cancer, metastatic pancreatic cancer, and early metastatic breast cancer. Lynparza is an oral medication that works as PARP inhibitor. PARP is a protein that repairs DNA damage in cells, including cancer cells. Lynparza works to stop PARP from repairing the damaged cells, helping to kill cancer cells.

    The medication is co-owned by Merck and AstraZeneca. The trial was conducted to determine whether or not the drugs can help patients who have stabilized or gone into remission following treatment with Avastin. Avastin is a medication used alongside with chemotherapy as an anti-angiogenic. It is often used to treat metastatic colorectal cancer.

    Lynparza has had its success especially with breast cancer. It helps prevent breast cancer from returning by 42% and lowers the risk of death by 32% in early breast cancer. However, Lynparza has not found its success with colorectal cancer. The trial was stopped at phase 3. The drug was tested alone as well as alongside Avastin. The result of the trial showed that given alone or with Avastin, did not extend survival in patients with metastatic disease.


    1. Becker, Z. (2022, July 19). In another Lynparza Flop, AstraZeneca, Merck pull the plug on a colorectal cancer trial. Fierce Pharma. Retrieved August 1, 2022, from https://www.fiercepharma.com/pharma/merck-astrazeneca-pull-plug-phase-3-lynparza-trial-colorectal-cancer#:~:text=As%20AstraZeneca%20and%20Merck%20try,was%20found%20unlikely%20to%20suceed

    2. Gardner, J. (2022, July 19). Merck terminates Lynparza trial in colorectal cancer. BiopharmaDive. Retrieved July 22, 2022, from https://www.biopharmadive.com/news/lynparza-fail-colorectal-cancer-/627585/.

    3. Lynparza® (OLAPARIB)- official patient website. (n.d.). Retrieved August 1, 2022, from https://www.lynparza.com/

  • cigarettes

    Tobacco and Vaping

    Madison Davis MPH Candidate, Brown University School of Public Health



    Vaping is an ongoing, dangerous, trend among adolescents. The increase in harmful side effects associated with vaping has led to concern among providers and public health officials. A vape, or an e-cigarette, allows individuals inhale a heated aerosol that usually contains nicotine1. A monitoring study in 2019 concluded that the prevalence of vaping increased two-fold among eighth grade, tenth grade, and twelfth grade students between 2017 and 20191. It is important to observe the increase in vaping among young individuals because of the detrimental effects nicotine has on developing teenagers2. During the adolescent period, generally defined as between 12 and 18 years of age, there are critical changes in cognitive and executive function, working memory, reward processing, emotional regulation, and motivated behavior2

    Going all the way back to your biochemistry class you took years ago, we are going to dive into the specific physiological effects of nicotine on the developing brain. The nicotinic acetylcholine receptors (nAChRs) are ligand-gated ion channels found throughout the brain2. These channels are responsible for regulating agonist affinity, ion selectivity, desensitization, and downstream signaling2. Given its versatile function, nAChRs plays a vital role in the central and peripheral nervous system2. However, these receptors have a high affinity for (or really enjoy binding to) nicotine which causes desensitization in the brain of a smoker2. There are other subtypes of the receptor that experience similar effects in the caudal brain region which plays an important role in the nicotine addiction pathway2. The activation of regions involved with the nicotine addiction pathway (that have high concentrations of nAChR receptors) causes nicotine-induced firing and activity of dopamine neurons in the brain2. This process occurs in many different brain regions affecting a variety of systems2. Nicotine also plays a similar and important role in the ascending serotonin system3.

    All of this means that the limbic system, which controls cognition, emotion, and drug reward, is very vulnerable to developmental issues when exposed to nicotine particularly during adolescence2. This sensitivity to nicotine suggests that smoking is not only associated with mood disorders, but may also be the cause4.

    Not only are there severe effects on the brain and nervous system, but also there can be major damage to the lungs of those who smoke. A 2019 study looked at the vaping-associated lung injuries in individuals who using vapes/e-cigerettes5. The presence of diacetyl in vapes is known to cause lung injuries5. The warning signs for providers is discussed further below. 

    Health Law

    In 2009, the Tobacco Control Act and “Deeming Rule” were passed to allow the FDA to establish regulations on cigarettes and new tobacco products including e-cigarettes6. More recently, in 2019, the federal government increased the age requirement to purchase e-cigarettes from 18 to 21 years of age6. In 2020, they went a step further to halt the sale of flavored cartridges and prevent the online sale of e-cigarettes in order to dissuade younger people from purchasing them6. Future law directions include a proposed regulation on the amount of nicotine that can be present in an e-cigarettes6

    Details for Providers

    Individuals who begin smoking during their adolescent life are more likely to use other drugs, engage in high-risk sexual behavior, and develop psychiatric disorders when compared to nonsmoking adolescents7,8. Given the clear developmental impact that nicotine has on the emotional, cognitive, and addiction pathways of the brain, this is where providers may see deficits in their patients who smoke2.  

    For patients with vaping-associated lung injuries, they may present with mild respiratory symptoms including persistent cough, shortness of breath, or chest pain5. However, there is not a clear clinic guideline for this type of illness. Instead, as a provider, you can make the diagnosis by establishing a temporal relationship between vaping and symptoms, rule-out other potential causes for symptoms, and determine if there is improvement with the cessation of smoking5. In regard to radiological findings, a hypersensitive pneumonitis pattern that was improved with cessation of smoking has been reported5. Additionally, diffuse alveolar hemorrhage, which presents with cough, fever, difficulty breathing, and sometimes coughing up blood, has been found as well5. Other conditions include acute lung injury, acute eosinophilic pneumonia organizing pneumonia, lipoid pneumonia, and giant cell interstitial pneumonia7.

    As a provider it is important to screen patients for smoking history and advise on the potential dangers of vaping particularly between the ages of 12 and 18 years. Furthermore, the cessation of smoking has been found to help improve associated symptoms and may be a valuable first step in treatment7



    1. Miech R, Johnston L, O’Malley PM, Bachman JG, Patrick ME. Trends in adolescent vaping, 2017–2019. New England Journal of Medicine. 2019;381(15):1490-1491.
    2. Yuan M, Cross SJ, Loughlin SE, Leslie FM. Nicotine and the adolescent brain. The Journal of physiology. 2015;593(16):3397-3412.
    3. Bang SJ, Commons KG. Age-dependent effects of initial exposure to nicotine on serotonin neurons. 2011;179:1-8.
    4. John U, Meyer C, Rumpf H-J, Hapke U. Smoking, nicotine dependence and psychiatric comorbidity—a population-based study including smoking cessation after three years. Drug and alcohol dependence. 2004;76(3):287-295.
    5. Henry TS, Kligerman SJ, Raptis CA, Mann H, Sechrist JW, Kanne JP. Imaging findings of vaping-associated lung injury. AJR Am J Roentgenol. 2020;214(3):498-505.
    6. Laura Summers M. Curbing the Youth Vaping Pandemic: A Review of How Utah’s Laws and Policies Compare Nationally and to Other States. 2021.
    7. Lai S, Lai H, Page JB, McCoy CB. The association between cigarette smoking and drug abuse in the United States. Journal of addictive diseases. 2000;19(4):11-24.
    8. Rashad I, Kaestner R. Teenage sex, drugs and alcohol use: problems identifying the cause of risky behaviors. Journal of health economics. 2004;23(3):493-503.


  • Monkeypox: What We Know and Where We Are Headed

    By: Madison Davis MPH Candidate, Brown University School of Public Health


           The monkeypox virus (MPV) was first reported in 1958 in a Copenhagen research facility containing monkeys1. However, the first human infection was not until 1970 when a nine-month-old child in the Democratic Republic of the Congo was diagnosed1,2. Although the virus has been primarily concentrated in African countries, it has recently spread to other regions2. MPV is transmitted via contact with animals who have infected lesions, body fluids, or respiratory droplets. The median age of those diagnosed ranges from 4-21 years of age2. The fatality rate is ~8.7%; however, there are marked differences between regions2. The escalation in MPV cases is believed to be due to a decrease in smallpox vaccination, which provides cross-protection, and new mutations in the virus1,2.

    Signs & Symptoms

    The symptoms of MPV include3,4:

    • Fever
    • Headache
    • Muscle aches and backache
    • Swollen lymph nodes
    • Chills
    • Exhaustion
    • Respiratory symptoms (sore throat, nasal congestion, and cough)
    • An itchy and painful rash located on or near the genitals, hands, feet, chest, face, or mouth
      • The rash will progress through stages prior to healing
      • The rash will appear like pimples or blisters

           The majority of people who are diagnosed with MPV will experience a rash that developed 1-4 days after flu-like symptoms3. The symptoms will usually appear within 3 weeks of exposure and last 2-4 weeks3. Anyone can get MPV, so it is important to be vigilant of developing symptoms and new or worsening rashes.

    Current Outbreak

           According to the Centers for Disease Control and Prevention website, between January 1, 2022, and July 29th, 2022, there have been 22,485 confirmed cases across 79 countries3. The United States, Spain, Germany, and the UK have reported the highest cases at 5,186, 4,298, 2,595, and 2,546 cases respectively3. In the United States, New York, California, and Illinois have the highest confirmed case numbers, reporting 1,345, 799, and 419 cases respectively3. Belgium was the first country to implement a 21-day quarantine for those infected1. The infections are reported to be both caused by human-to-human transmission and animal-to-human transmission1.

           The CDC is working to collaborate with other countries who are also experiencing a marked increase in MPV cases to expand testing and track the evolution of the virus3.

    Spread, Testing & Prevention

           MPV can spread through contact with infectious rash or bodily fluids, respiratory droplets during prolonged face-to-face contact, touching objects or fabrics that infectious rash or fluids have touched, or being scratched or bitten by an infected animal3. The infection can be spread from the time that symptoms start to when the rash has fully healed3.

           If a person is experiencing symptoms of MPV, a lesion swab can be conducted in order to test for the presence of the MPV4. Ideally, there should be more than one specimen taken from two separate lesions on different parts of the body5. The lesion should be “unroofed” to properly sample the secretions5.

           Prevent close, skin-to-skin contact with people who have a rash associated with MPV and  avoid objects an infected person has used such as utensils, cups, bedding, or clothing3. Furthermore, washing your hands frequency with soap and warm water and consistently using an alcohol-based hand sanitizer can help prevent infection3.

    Recommendations for Providers

           The CDC, Health Alert Network (HAN), and Clinician Outreach and Communication Activity (COCA) ask providers to be alert to patients who are experiencing a new rash and have other associated MPV symptoms3. Providers can also conduct testing through the Laboratory Response Network, advise patients on health monitoring, and track confirmed cases3. Additionally, providers can subscribe to the COCA Now email updates and Health Alert Network messages to receive information on testing options. Lastly, providers are able to educate patients on and distribute vaccines to individuals who may be diagnosed or a part of a high risk population3.

           When treating patients with known or suspected MPV, it is recommended that providers don PPE for contact precautions including eye protection, a fit-tested N-95 or equivalent, gown, and gloves5. Furthermore, surfaces should be decontaminated, and the patient should be isolated5.

           Given the similarity in genetic makeup of the smallpox virus and MPV, it is believed that the antivirals and vaccines that aid with smallpox treatment will also help with MPV3. The CDC recommends antiviral treatment (tecovirimat (TPOXX), cidofovir, and brincidofovir)  for severely ill and immunocompromised patients3. These medications can be accessed through the CDC by submitting a request to the state and territorial health departments5. Furthermore, PEP vaccines, ACAM2000 or JYNNEOS, are recommended for intermediate to high-risk individuals who have been exposed via unprotected contact with an infected rash or being less than six feet from an unmasked person for more than three hours without wearing a surgical mask4. Supportive care is also recommended as treatment, including fluid maintenance, supplemental oxygen, and treatment of bacterial skin lesions where applicable5.

           Given the potentially stigmatizing nature of MPV, the CDC has released a report on how to effectively communicate MPV information without using stigmatizing language or marginalizing specific groups. 

    More Resources

           Given the evolving and novel nature of MPV, it is important to educate ourselves as providers to ensure we are implementing best practices for our patients. Here are some additional sources for reference:

    Monkeypox vaccines in pregnancy

    The use of JYNNEOS as a PEP vaccine

    Overview of monkeypox biology

    Monkeypox transmission in healthcare facilities

    Social consideration for monkeypox response



      1. pathobiology of the monkeypox virus. Journal of Autoimmunity. 2022:102855.
      2. Bunge EM, Hoet B, Chen L, et al. The changing epidemiology of human monkeypox—A potential threat? A systematic review. PLoS neglected tropical diseases. 2022;16(2):e0010141.
      3. Monkeypox. 2022; https://www.cdc.gov/poxvirus/monkeypox/response/2022/world-map.html.
      4. Minhaj FS, Ogale YP, Whitehill F, et al. Monkeypox outbreak—nine states, May 2022. Morbidity and Mortality Weekly Report. 2022;71(23):764.
      5. Titanji BK, Tegomoh B, Nematollahi S, Konomos M, Kulkarni PA. Monkeypox: A Contemporary Review for Healthcare Professionals. Paper presented at: Open Forum Infectious Diseases2022.
  • HPV Vaccine: Not Just for Women

    By: Madison Davis MPH Candidate, Brown University School of Public Health

    Background: Human Papillomavirus

           The human papillomavirus (HPV) is associated with cervical, anus, penile, vagina, vulva, and oropharynx cancers and is the most common sexually transmitted infection in the United States as of 20151-3. The virus is associated with a wide range of anogenital cancers due to its wide range of genotypes1. Cervical cancer specifically is the fourth most common cancer among women making it a significant health burden1. Furthermore, the HPV virus accounts for approximately 70% of cervical cancers and is also responsible for the majority of vaginal and vulvar cancer diagnosis among women.

           Given that cervical cancer is a major public health issue, it is often the disease that is most commonly associated with HPV; however, the HPV virus is significantly associated with other types of cancers found in both men and women. The HPV virus is attributed to 95% of anal cancer cases among men and women which have an incidence rate that has increased by more than 50% in the United States4, Scotland5, Denmark6, and Australia7-9. Furthermore, men who have sex with men have higher rates of HPV infection and HPV-associated anal cancer10. Additionally, the incidence rate of HPV-associated penile cancer has also increased in developing countries where it makes up 10% of cancer diagnosis11

    HPV Vaccine for Women

           The FDA has approved three different HPV vaccines: quadrivalent vaccine for males and females, a bivalent vaccine for females, and a 9-valent vaccine for males and females12. A study of over 17,000 women between the ages of 15 and 26 showed 100% efficacy in preventing HPV-associated cervical intraepithelial neoplasia 2 and 3, and cervical adenocarcinoma13

    HPV Vaccine for Men

           Despite targeted marketing toward female patients, the rate of HPV infection is nearly the same among men and women14. Furthermore, the prophylactic HPV vaccine shows significant protection from anogenital infection and external genital lesions associated with HPV among men between 16 and 26 years of age2. Specifically, the vaccine showed 60.2% efficacy against HPV infection in a 2011 study of 4065 heterosexual men and men who have sex with men2. An additional study in 2019 showed an 83.3% efficacy rate after six months15. To further support this, a 10-year longitudinal study also found an 85.6% efficacy rate at preventing HPV infection among men16. Although the efficacy rate of the vaccine is higher in women, the confidence intervals overlap which suggests that the vaccine is effective for both populations2.

    Implementation Into Practice

           The development of screening programs has been a pivotal change in the approach to treating cancer. Like many other cancers, the stage at which cervical cancer is detected is one of the best prognostic factors for survival1. Although screening measures have been important in diagnosing cancer early, and thus reducing the mortality rate, there has been little change in the incidence rate of cancer in areas that have strong screening programs thus highlighting the need for increased vaccination1.

           The HPV vaccine has been shown to be effective in both men and women at preventing devastating cancers with little to no reported side effects thus it should be marketed to both populations. The previous argument for only vaccinating women was that if herd immunity was reach among the female population, then it would limit transmission to the male population; however, this excludes men who have sex with men, a vulnerable population to HPV infection17. Therefore, vaccination of both men and women is the best way to reach all vulnerable populations and limit the spread of HPV. In your own practice, consider speaking with both your male and female patients about the HPV vaccine to determine if partaking in the immunization series would be best for them.


    1. Wakeham K, Kavanagh K. The burden of HPV-associated anogenital cancers. Current oncology reports. 2014;16(9):1-11.
    2. Giuliano AR, Palefsky JM, Goldstone S, et al. Efficacy of quadrivalent HPV vaccine against HPV Infection and disease in males. New England Journal of Medicine. 2011;364(5):401-411.
    3. Hariri S, Unger ER, Sternberg M, et al. Prevalence of genital human papillomavirus among females in the United States, the National Health and Nutrition Examination Survey, 2003–2006. Journal of Infectious Diseases. 2011;204(4):566-573.
    4. Johnson LG, Madeleine MM, Newcomer LM, Schwartz SM, Daling JR. Anal cancer incidence and survival: the surveillance, epidemiology, and end results experience, 1973–2000. Cancer. 2004;101(2):281-288.
    5. Brewster D, Bhatti L. Increasing incidence of squamous cell carcinoma of the anus in Scotland, 1975–2002. British journal of cancer. 2006;95(1):87-90.
    6. Frisch M, Melbye M, Møller H. Trends in incidence of anal cancer in Denmark. British Medical Journal. 1993;306(6875):419-422.
    7. Daling JR, Madeleine MM, Johnson LG, et al. Human papillomavirus, smoking, and sexual practices in the etiology of anal cancer. Cancer. 2004;101(2):270-280.
    8. Jin F, Stein AN, Conway EL, et al. Trends in anal cancer in Australia, 1982–2005. Vaccine. 2011;29(12):2322-2327.
    9. Baricevic I, He X, Chakrabarty B, et al. High-sensitivity human papilloma virus genotyping reveals near universal positivity in anal squamous cell carcinoma: different implications for vaccine prevention and prognosis. European journal of cancer. 2015;51(6):776-785.
    10. Palefsky J. Human papillomavirus and anal neoplasia. Current HIV/AIDS Reports. 2008;5(2):78-85.
    11. Ornellas AA. Management of penile cancer. In. Vol 972008:199-200.
    12. Food U, Administration D. Vaccines, blood, and biologics: human papillomavirus vaccine. In:2015.
    13. Group FIS. Prophylactic efficacy of a quadrivalent human papillomavirus (HPV) vaccine in women with virological evidence of HPV infection. The Journal of infectious diseases. 2007;196(10):1438-1446.
    14. Yoshida T, Ogawa T, Nakanome A, et al. Investigation of the diversity of human papillomavirus 16 variants and L1 antigenic regions relevant for the prevention of human papillomavirus-related oropharyngeal cancer in Japan. Auris Nasus Larynx. 2022.
    15. Mikamo H, Yamagishi Y, Murata S, et al. Efficacy, safety, and immunogenicity of a quadrivalent HPV vaccine in Japanese men: a randomized, Phase 3, placebo-controlled study. Vaccine. 2019;37(12):1651-1658.
    16. Goldstone S, Giuliano A, Palefsky J, Luxembourg A, team V-s. Long-term effectiveness and immunogenicity of quadrivalent HPV vaccine in young men: 10-year end-of study analysis. In: American Society of Clinical Oncology; 2018.
    17. Spînu AD, Anghel RF, Marcu DR, Iorga DL, Cherciu A, Mischianu DLD. HPV vaccine for men: Where to? Experimental and Therapeutic Medicine. 2021;22(5):1-6.
  • Celebrating HIV Awareness Month with Clinical Practice Updates on PrEP

    By: Ellen Smith, MSN, MPH, NP-C, WHNP-BC, CIC, CPH 

           Given the COVID-19 pandemic over the past two years, many nurse practitioners may be unfamiliar with recent clinical practice updates and treatment options in other corners of the infection control field. As we celebrate the month of July as HIV Awareness Month, we turn our attention to developments in the field of HIV prevention, namely HIV PrEP (Pre-exposure prophylaxis). Pre-exposure prophylaxis consists of medications that are prescribed to people at risk for HIV acquisition (such as people who use IV drugs or have high-risk sex)1. When taken as prescribed, PrEP reduces the risk of acquiring HIV through sex by about 99% and reduces the risk of acquiring HIV through IV drug use by at least 74%1. Given that 1.7 million people are newly infected with HIV each year, PrEP has been a huge breakthrough in the HIV field2. However, it is dependent on prescribers being familiar with its use and effectively counseling people who may benefit.  

           The CDC now recommends talking about PrEP to all sexually active adolescents and adults and offering PrEP to all those who request it; including those who do not report a history of high-risk sexual activity or drug use3. Given the stigma that still surrounds HIV, this strategy helps patients overcome embarrassment or shame. In addition to stigma, another barrier that has prevented patients from seeking PrEP is the cost; however, as of July 2021, the federal government announced that nearly all health insurers are required to cover not only the cost of PrEP medications but associated lab tests and clinic visits as well4. A barrier to compliance is patient’s reluctance to take a daily pill, even if it can have such a positive benefit. A new injectable treatment option (Cabotegravir) has surmounted this obstacle. One injection of Cabotegravir prevents HIV infection for up to 2 months3. It was approved by the FDA in 2021 and may be particularly beneficial for patients who have a hard time taking oral medications as prescribed, have severe kidney disease, or simply prefer more infrequent medication administration3. The final obstacle to maximizing the utility of PrEP is prescriber and patient awareness.  

           This HIV Awareness Month, make it a point to talk about PrEP with your colleagues and friends. Also, get into the habit of discussing the benefits of PrEP with your patients. Given the wide availability of this effective tool, now is the time to step up our fight against HIV! For more prescriber information, visit the updated PrEP guideline from the CDC at www.cdc.gov/hiv/pdg/risk/prep/cdc-hiv-prep-guidelines-2021.pdf 



      1. PrEP Effectiveness. Centers for Disease Control and Prevention. Updated May 13, 2021. Accessed May 16th, 2022. https://www.cdc.gov/hiv/basics/prep/prep-effectiveness.html 
      2. Global statistics. HIV.gov. Updated November 30th, 2021. Accessed May 16th, 2021. https://www.hiv.gov/hiv-basics/overview/data-and-trends/global-statistics 
      3. Clinicians’ Quick Guide. Centers for Disease Control and Prevention. Accessed May 16th, 2021. https://www.cdc.gov/hiv/pdf/clinicians/materials/cdc-hiv-FlyerPrEPUpdateProvider508.pdf
      4. Ryan, Benjamin. PrEP, the HIV prevention pill, must now be totally free under almost all insurance plans. NBC News. July 20th, 2021. Accessed May 16th, 2021. https://www.nbcnews.com/news/amp/rcna1470  
  • Accidental Drowning in Children: Overview, Prevention, and Treatment

    By: Madison Davis MPH Candidate, Brown University School of Public Health


           Drowning can be defined as being unable to breathe as a result of being submerged in water. When a person is submerged underwater, they experience a laryngeal spasm reflex which closes off their airway and prevents oxygen from going to the brain1. Accidental drowning is one of the leading causes of death among children in the United States2. Specifically, drowning is the second leading cause of death among children between the ages of 1 and 142. As we approach warmer months, it is important to understand how to prevent and treat as numbers will be on the rise. On average, there are about 3,960 fatal and 8,080 nonfatal, accidental drownings per year2,3. Even in the case on nonfatal accidental drownings, more than 40% of children treated in the emergency department subsequently require hospitalization or relocation for more intense care2.

    At Risk Population

           Children between the ages of 1 and 4 are most at risk2. Drownings among children tend to occur in swimming pools3. Males are also more at risk than females for fatal, accidental drownings2. This is often due to increased exposure to water, increased risk-taking behaviors, and alcohol use4,5. Black children between 10 and 14 are 7.6 times more likely to die from accidental drowning than white children6.

    Secondary Drowning

           Secondary drowning is when a water enters the lungs/airway of a child prior to the laryngeal spasm reflex1. If excessive amounts of water enter the airway, lung damage can occur and become more serious 6-12 hours after the incident1. The signs and symptoms of secondary drowning include1:

    • Change of skin color
    • Heavy coughing
    • High fever
    • Loss of consciousness
    • Shortness of breath
    • Vomiting


           The most important factor in treating someone who has experienced a drowning is ventilation7. Oxygenation, ventilation, and perfusion should be the top priority; thus, CPR should be administered as soon as possible7. A secondary factor in treating those who have experienced a drowning is the possible presence of primary or secondary hypothermia8. However, c-spine stabilization is not indicated unless there was trauma involved in the drowning incident7. Common trauma incidents include diving, water slides, signs of injury, or alcohol intoxication7. There is also not a need to remove small amount of aspirated water from the victim’s mouth or perform the abdominal thrusts or the Heimlich maneuver7.

           Pulling the victim from the water quickly is important7. Prompt ventilation via mouth-to-mouth or BVM is recommended: 2 rescue breathes should be administered once removed from water7. If the victim does not have a pulse, then chest compressions should subsequently begin7. Cycles of CPR should continue until a pulse is returned7. If an AED is present, that should be properly used on the patient if indicated7. If the patient vomits during CPR, then they should be rolled on their side and the vomit should be suctioned out or removed by the rescuer7.

           Some modifications to ACLS include the use of surfactant for fresh water-induced drownings and extracorporeal membrane oxygenation for cases of severe hypothermia9-13. However, the use of barbiturates, steroid, nitric oxide, therapeutic hypothermia, or vasopressin are not supported14-17.  


           Many fatal, accidental drownings occur due to children who are unable to swim having access to water5. This could be due to ineffective fencing around pools, a lack of supervision and life jackets, or the consumption of drugs and alcohol5. However, the common location of drownings for each age varies. The highest risk of drowning for infants under 1 year is reported to occur in bathtubs; however, for children 1-4 years of age, drownings tend to occur in residential swimming pools3. Furthermore, for adolescents 15 years or older, the majority of drownings both fatal and nonfatal occur in natural bodies of water such as lakes, rivers, or oceans3.

           There are a few important precautions that can be taken to avoid a drowning incident. While in a natural body of water, look for steep drops, hazardous currents, or opaque water18. For at home pools, it is vital to have a safe perimeter to prevent accidents or unsupervised swimming18. In any body of water, if not a strong swimmer, swimming with friends, wearing a life jacket, having a dedicated watcher/constant supervision, and understanding basic first aid is important18. Furthermore, checking side effects of medications to ensure they do not make you drowsy or impaired and consulting a provider on medication use while swimming18.



    1. ‘Dry Drowning’: Separating Fact From Fiction. Pediatrics 2020; https://health.clevelandclinic.org/dry-drowning-separating-fact-from-fiction/.
    2. Web-based Injury Statistics Query and Reporting System (WISQARS). 2021; http://www.cdc.gov/injury/wisqars.
    3. Wide-ranging Online Data for Epidemiologic Research (WONDER). 2021; https://wonder.cdc.gov/.
    4. Lawes J, Ellis A, Daw S, Strasiotto L. Risky business: a 15-year analysis of fatal coastal drowning of young male adults in Australia. Injury prevention. 2020.
    5. Denny S, Quan L, Gilchrist J, et al. Policy Statement – Prevention of Drowning American Academy of Pediatrics (AAP) – Council on Injury, Violence, and Poison Prevention. 2019;143(5).
    6. Clemens T, Moreland B, Lee R. Persistent Racial/Ethnic Disparities in Fatal Unintentional Drowning Rates Among Persons Aged ≤29 Years – United States, 1999-2019. MMWR. 2021.
    7. Part 10.3: Drowning. American Heart Association. 2005;112:133-135.
    8. Quan L, Kinder D. Pediatric submersions: prehospital predictors of outcome. Pediatrics. 1992;90(6):909-913.
    9. Bolte RG, Black PG, Bowers RS, Thorne JK, Corneli HM. The use of extracorporeal rewarming in a child submerged for 66 minutes. Jama. 1988;260(3):377-379.
    10. Onarheim H, Vik V. Porcine surfactant (Curosurf) for acute respiratory failure after near‐drowning in 12 year old. Acta anaesthesiologica scandinavica. 2004;48(6):778-781.
    11. Staudinger T, Bankier A, Strohmaier W, et al. Exogenous surfactant therapy in a patient with adult respiratory distress syndrome after near drowning. Resuscitation. 1997;35(2):179-182.
    12. Suzuki H, Ohta T, Iwata K, Yamaguchi K, Sato T. Surfactant therapy for respiratory failure due to near-drowning. European journal of pediatrics. 1996;155(5):383-384.
    13. Thalmann M, Trampitsch E, Haberfellner N, Eisendle E, Kraschl R, Kobinia G. Resuscitaton in near drowning with extracorporeal membrane oxygenation. The Annals of thoracic surgery. 2001;72(2):607-608.
    14. Foex BA, Boyd R. Corticosteroids in the management of near-drowning. Emergency Medicine Journal. 2001;18(6):465-466.
    15. Takano Y, Hirosako S, Yamaguchi T, et al. Nitric oxide inhalation as an effective therapy for acute respiratory distress syndrome due to near-drowning: a case report. Nihon Kokyuki Gakkai Zasshi= the Journal of the Japanese Respiratory Society. 1999;37(12):997-1002.
    16. Williamson JP, Braude S, Illing R, Gertler P. Near-drowning treated with therapeutic hypothermia. The Medical Journal of Australia. 2004;181(9):500-501.
    17. Sumann G, Krismer A, Wenzel V, et al. Cardiopulmonary resuscitation after near drowning and hypothermia: restoration of spontaneous circulation after vasopressin. Acta anaesthesiologica scandinavica. 2003;47(3):363-365.
    18. Drowning data and facts. https://www.mass.gov/service-details/drowning-data-and-facts.
  • LGBTQ+ Health: Becoming an LGBTQ-Competent Provider

    By: Madison Davis MPH Candidate, Brown University School of Public Health

    The History Behind Pride Month

           The month of June celebrates LGBTQ+ Pride Month after the Stonewall Uprising on June 28th in 1969. In the 1960s, it was common for police to unjustly raid gay bars in New York City. In the past, the patrons would accept the raids passively despite them being unfounded. However, on June 28th, the patrons of the Stonewall Inn bar would no longer allow the harassment to be met with inaction. The patrons fought back on police who raided the bar that night. This resistance allowed for a new precedent to be set: the LGBTQ+ community would not allow discrimination and persecution to continue.

           The following year, on June 28th, 1970, New York City residents marched in the streets to celebrate and commemorate the Stonewall Uprising. This would later be considered the first pride parade. This uprising and its subsequent celebration led to a major shift in the LGBTQ+ rights movement and marked an important catalyst in the push for equality.

    Timeline of the LGBTQ+ Rights Movement

    LGBTQ+ and Healthcare

    The Use of Pre-Exposure Prophylaxis (PrEP)

           The creation of PrEP is a major step in the fight against the HIV/AIDs epidemic. PrEP is a medication that reduces your chances of getting HIV by 99% if exposed via sex. PrEP can be administered in the form of a pill or shots: Truvada and Descovy being the two approved pills and Apretude being the approved shot. There is flexibility with administration. If a person were to want to switch from pills to shots or vice versa, they could speak with their healthcare provider.

           Individuals recommended to use PrEP  include those who have had anal or vaginal sex in the past 6 months and have a sexual partner who has HIV, have not used a condom consistently, or have been diagnosed with an STI in the past 6 months. PrEP can be used by any person over 77lbs and are at risk of HIV.

           Those with insurance or state Medicaid have access to PrEP at no cost. If an individual does not have insurance, then they can use one of the following programs to obtain PrEP at little or no cost: Ready, Set PrEP, Co-Pay Assistance Program, ViiVConnect, or PrEP Assistance Program.

           In order to start taking PrEP either an in-person or virtual appointment with a healthcare provider must be scheduled and an in-person or at-home HIV test must be completed. Once prescribed, routine visits are necessary for subsequent HIV tests and refills.

           On-Demand PrEP refers to a way to take PrEP only when an individual is at risk for HIV. This means they would use a 2-1-1 schedule: taking 2 pills 24 hours before sex, 1 pill 24 hours after the first dose, and 1 pill 24 hours after the second dose. This method has been effective in preventing HIV among gay and bisexual men who have anal sex without a condom; however, this has not been tested for heterosexual or transgender individuals who are at risk. This approach is not approved by the FDA and not recommended by the CDC.

    LGBTQ-Competent Care

           LGBTQ-competent care is pivotal in decreasing barriers to access and improving the experience for the LGBTQ community. As of 2019, individuals a part of the LGBTQ community report not having sufficient choice or access to LGBTQ-competent providers who are in-network with their insurance. Additionally, they report being denied coverage for LGBTQ-specific medical service such as HIV medications, PrEP, hormones, PEP, HPV, and gender-affirming care.

           There are also major barriers to care for the LGBTQ+ community. Some of these include resources to pay out of pocket, not enough adequately trained providers, the assumption by providers that the individual is cis-gendered and heterosexual, provider fear or dislike of LGBTQ+ people, and not knowing how to access LGBTQ-component providers. 

    The qualities of a competent providers include:

    • Being comfortable with sexual orientation and gender identity
    • Asking about sexual orientation, gender identity, and relationship status
    • Having LGBTQ-inclusive forms that list sexual orientation, gender identity, and relationship status
    • Using gender-neutral language when talking about reproductive health, sexual health, and or relationship status
    • Having signs, posters, and other visible signals that the office setting is LGBTQ-inclusive
    • Including sexual orientation and gender identity in the organization’s posted non-discrimination statement
    • Having gender-neutral restrooms
    • Having LGBTQ people on staff
    • Asking and addressing patients by their correct pronouns
    • Asking and addressing patients by their chosen name if different from legal name
    • Having trained frontline and medical support staff on LGBTQ competency
    • Having knowledge on transgender-specific and related health care needs
    • Being comfortable with patients who identify as transgender
    • Addressing patient’s transgender-specific healthcare needs, not only other medical needs
    • Having office forms and policies that are transgender-inclusive
    • Having specific knowledge or training to deliver healthcare services to LGBTQ people

           By integrating the above qualities into your practice, your LGBTQ patients will feel more comfortable with your practice and are more likely to receive high-quality, patient-centered care.

    Gender-Affirming Care

           Gender-affirming care encompasses medical practices such as hormone replacement therapy, surgical interventions, and non-medical care such as legal or social support while transitioning. This type of care is recognized as medically necessary by both national and global organizations. At this time, however, Alabama, Arkansas, Arizona, and Texas have restricted youth-access to gender-affirming care. The restrictions on gender-affirming care include:

    • Criminalizing or imposing professional disciplinary action against healthcare providers who offer this care
    • Penalizing parents aiding in youth-access to this care
    • Allowing individuals to file for damages against providers who provide such care
    • Limit insurance coverage or payment for such care

           However, the American Medical Association, American Academy of Pediatrics, the Endocrine Society, American Psychological Association, American Psychiatric Association, and the World Professional Association of Transgender Health have all released statements supporting gender-affirming care and deeming it medically necessary for both youths and adults. 


           LGBTQ+ youth report higher rates of depression, anxiety and suicidality when compared to their non-LGBTQ+ peers. Transgender youth specifically report higher suicide risk outcomes including having felt sad or hopeless, considering attempting suicide, making a suicide plan, attempting suicide, or had a suicide attempt treated by a provider when compared to their cis-gendered peers. Furthermore, a lack of access to gender-affirming care has been significantly tied to worse mental health outcomes. Within healthcare spaces, LGBTQ individuals report higher rates of negative experiences with providers when compared to non-LGBTQ individuals.

           Being an LGBTQ-competent provider and providing gender-affirming care is necessary to providing patient-centered, quality care. These are basic steps that can be taken on the provider side to ensure patients are feeling respected and valued by their provider. Furthermore, access to competent care significantly impacts patient’s mental health. Revisit the above qualities of a LGBTQ-competent provider and explore ways to include gender-affirming care in your practice.

    Blood Donation

           Prior to 2015, a man who had sex with other men at any point in their lifetime were banned from donating blood. In December of 2015, the FDA revised this ban to exclude men who had sex with men in the last 12 months. However, in 2020, the FDA revised this policy again to say exclude men who had sex with men in the past 3 months.

           There are rigorous and extensive tests that donated blood undergoes, including tests for the presence of HIV, hepatitis, syphilis, and other blood-borne diseases. However, for the approximately 12 million units tested per year, approximately 10 HIV-infected units have slipped through due to faulty results. Given this, the FDA still excludes men who had sex with men in the last 3 months from donating.

           However, the federal policy is not preventing risky behavior but rather a general group from donating. Women who have unprotected sex with multiple men and women are still able to donate, but a man who has protected sex with another man is unable to donate. This highlights a clear example of the FDA discriminating against a group rather than a risk factor. The Human Rights Campaign suggests the FDA should alter their pre-donation questionnaire to inquire about risky sexual behavior rather than sexual orientation or gender identity.     


           As healthcare providers, it is our job to provide compassionate, high-quality, and patient-centered care regardless of the patient’s sexual orientation or gender identity. By adjusting our practice to include gender-affirming care where appropriate, educating ourselves on LGBTQ+ history, and learning how to provide LGBTQ-competent care, we can help improve mental health, improve access to care, and make an impactful difference in the lives of our LGBTQ+ patients.



    1. About PrEP.  Center for Disease Prevention and Control. https://www.cdc.gov/hiv/basics/prep/about-prep.html
    2. Blood Donations.  Human Rights Campaign. https://www.hrc.org/resources/blood-donations
    3. Closing the Gap: The Turning Point for LGBTQ Health. (2019). https://drive.google.com/file/d/1wE_87-h1JP1Ge8m_rb7SnrvBZjN8LE7L/view
    4. Dawson, L., Kates, J., & Musumeci, M. (2022). Youth Access to Gender Affirming Care: The Federal and State Policy Landscape. https://www.kff.org/other/issue-brief/youth-access-to-gender-affirming-care-the-federal-and-state-policy-landscape/#:~:text=Gender%2Daffirming%20care%20is%20a,affirm%20an%20individual’s%20gender%20identity.%E2%80%9D
    5. Guillen, L. Same-Sex Marriage Now the Law of the Land. https://www.nolo.com/legal-encyclopedia/same-sex-marriage-now-the-law-the-land.html#:~:text=Gay%20Marriage%20Is%20Legal%20in,cannot%20ban%20same%2Dsex%20marriage
    6. Klein, K. (2022). Gender-Affirming Care and HCH: Definitions, Resources, and Opportunities Insights from the HCH Helpdesk.
    7. Pride Month: The History and Meaning Behind It. (2021).  Mental Health Association in Delaware. https://www.mhainde.org/pride-month-the-history-and-meaning-behind-it/?gclid=CjwKCAjwtcCVBhA0EiwAT1fY7-0AckBX2npBjmy36pEBopLCmuXsFgWpAdMVnFRTP13rLrVkCvF6ghoCoW8QAvD_BwE
    8. Stonewall Riots. (2017).  A&E Television Networks. https://www.history.com/topics/gay-rights/the-stonewall-riots
    9. Suits, D. (2021). Change to policy allows transgender Soldiers to serve openly. Army News Service. https://www.army.mil/article/247785/change_to_policy_allows_transgender_soldiers_to_serve_openly
  • Is Mycoplasma genitalium the next chlamydia?

    By: Casey N. Pinto PhD, CRNP, MPH, The Pennsylvania State University, Department of Public health Sciences

           Chlamydia was discovered in 1907 but was not associated with non-gonococcal urethritis (NGU) until the 1970s. In 1988 the CDC made chlamydia a nationally notifiable disease in the US. In 1990 there were 34,000 cases documented,1,2 rising to nearly 1.6 million cases in 2020.3 Prevalence rates of chlamydia among the general population is 2.3%4 however, rates vary between 1.4% and 14% based on select social determinants and age.2,5,6

           Mycoplasma genitalium (MG) was discovered in 1981 during a search for causative agents of NGU.7,8 However, since the MG bacteria took six months to grow on very specific culture mediums, clinical diagnosis was limited to clinical suspicion. The first assay for MG was approved by the FDA in the US in 2019,9 allowing for improved diagnosis and prevalence estimates. Current prevalence of MG is 1% among the general US population4 with a range of 4-38% among select population groups.10-14 Thus MG is more prevalent than gonorrhea (0.4%),4 and is quickly catching chlamydia, and surpassing in select populations.

           Initial symptoms of MG are mild (urethritis/cervicitis/proctitis) with limited information on long-term effects. Existing evidence is predominantly among women (endometritis, pelvic inflammatory disease, preterm birth, fetal demise, and infertility).15-17 Among men it is theorized that infertility, epididymitis, and/or prostatitis are potential long-term effects.18,19

           MG screening guidelines are continually adjusted based on new evidence. Currently, screening is limited to patients who are symptomatic and includes urine, vaginal, meatal, rectal, and endocervical sites as indicated.19 Asymptomatic screening should not include MG 19 unless clinical decision making justifies screening (i.e. partner positive and unable to clear infection). Symptomatic patients who test positive for MG require treatment. Asymptomatic patients with a positive MG test should be considered for treatment based on clinical judgement, especially since there is evidence that 93% of patients will clear an MG infection without any treatment at 12 months.20

           Treatment for MG initially mirrored chlamydia treatment (azithromycin 1gm PO) however, increasing macrolide resistance has been documented among MG isolates (44%-90%).19 Due to the high rate of macrolide resistance, and the lack of resistance testing in the US (currently available in other countries),21 azithromycin should be avoided as a treatment for proven or suspected MG. The current recommendations are doxycycline 100mg PO BID x 7days followed by moxifloxacin 400mg PO daily x 7 days. Doxycycline alone will not adequately treat the infection but will decrease the bacteria burden. So moxifloxacin can successfully eradicate the infection without increasing the rate of resistance among fluoroquinolones.22 While the 7-day doxycycline treatment followed by moxifloxacin is cumbersome, it does allow time for MG testing results to determine if the second antibiotic is needed. Additionally, when resistance testing is available in the US, the 7-day doxycycline window will allow time to determine the appropriate second antibiotic.

           MG is not only likely to be the next chlamydia, but the high likelihood of developing resistance will complicate current and future treatment. Providers should be suspicious of MG in cases of NGU to ensure appropriate and timely treatment.


    1. Taylor-Robinson D. The discovery of Chlamydia trachomatis. Sex Transm Infect. 2017;93:10.
    2. Miller WC. Prevalence of Chlamydial and Gonococcal Infections Among Young Adults in the United States. JAMA. 2004;291(18):2229.
    3. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2020. 2021.
    4. Manhart LE, Holmes KK, Hughes JP, Houston LS, Totten PA. Mycoplasma genitalium Among Young Adults in the United States: An Emerging Sexually Transmitted Infection. American Journal of Public Health. 2007;97(6):1118-1125.
    5. Torrone EAP, John; Weinstock, Hillard. Prevalence of Chlamydia trachomatis Genital Infection Among Persons Aged 14-39 years — United States, 2007-2012. Morbidity and Mortality Weekly Report. 2014;63(38):834-838.
    6. Force USPST. Final Recommendation Statement: Chlamydia and Gonorrhea: Screening – US Preventive Services Task Force. In:2019.
    7. Tully JG, Taylor-Robinson, David., Cole, Roger M., Rose, David L.,. A Newly Discovered Mycoplasma in the Human Urogenital Tract. The Lancet. 1981:1288-1291.
    8. Taylor-Robinson D, Tully, J.G., Furr, P.M., Cole, R.M., Rose, D. L., Hanna, N.F.,. Urogenital mycoplasma infections of man: a review with ovservations on a recently discovered mycoplasma. Isr J Med Sci. 1981;17(7):524-530.
    9. FDA permits marketing of first test to aid in the diagnosis of a sexually-transmitted infection known as Mycoplasma genitalium [press release]. 2019.
    10. le Roux MCH, Anwar Ahmed. Quantitative Real-Time Polymerase Chain Reaction for the Diagnosis of Mycoplasma genitalium Infection in South African Men With and Without Symptoms of Urethritis. Sex Transm Dis. 2017;144:18-21.
    11. Munson E, Wenten D, Jhansale S, et al. Expansion of Comprehensive Screening of Male Sexually Transmitted Infection Clinic Attendees with Mycoplasma genitalium and Trichomonas vaginalis Molecular Assessment: a Retrospective Analysis. Journal of Clinical Microbiology. 2017;55(1):321-325.
    12. Getman DJ, A., O’Donnell, Meghan., Cohen, Seth. Mycoplasma genitalium Prevalence, Coinfection, and Macrolide Antibiotic Resistance Frequency in a Multicenter Clinical Study Cohort in the United States. J Clin Microbiol. 2016;54(9):2278-2283.
    13. Seña AC, Lee JY, Schwebke J, et al. A Silent Epidemic: The Prevalence, Incidence and Persistence of Mycoplasma genitalium Among Young, Asymptomatic High-Risk Women in the United States. Clinical Infectious Diseases. 2018;67(1):73-79.
    14. Hancock EB, Manhart LE, Nelson SJ, Kerani R, Wroblewski JKH, Totten PA. Comprehensive Assessment of Sociodemographic and Behavioral Risk Factors for Mycoplasma genitalium Infection in Women. Sexually Transmitted Diseases. 2010;37(12):777-783.
    15. Frenzer C, Egli-Gany D, Vallely LM, Vallely AJ, Low N. Adverse pregnancy and perinatal outcomes associated with <i>Mycoplasma genitalium:</i> systematic review and meta-analysis. Sex Transm Infect. 2022;98(3):222-227.
    16. Cazanave C, Manhart L. E., Bebear, C. Mycoplasma genitalium, an emerging sexually transmitted pathogen. Medecine et Maladies Infectieuses. 2012;42(9):381-392.
    17. Vazquez F, Fernández J. Pelvic Inflammatory Disease Due to <i>Mycoplasma genitalium</i>: A Character in Search of an Author. Clinical Infectious Diseases. 2020;71(10):2723-2725.
    18. Ahmadi MHM, Akbar; Gilani, Mohammad Ali Sadighi; Bahador, Abbas; Talebi, Malihe Improvement of semen parameters after antibiotic therapy in asymptomatic infertile men infected with Mycoplasma genitalium. Infection. 2018;46:31-38.
    19. Centers for Disease Control and Prevention. Sexually Transmitted Infections Treatment Guidelines, 2021. Morbidity and Mortality Weekly Report. 2021;70(4):1-187.
    20. Vandepitte J, Weiss HA, Kyakuwa N, et al. Natural history of Mycoplasma genitalium Infection in a Cohort of Female Sex Workers in Kampala, Uganda. Sexually Transmitted Diseases. 2013;40(5):422-427.
    21. Manhart LE. Editorial Commentary: Diagnostic and Resistance Testing for Mycoplasma genitalium: What Will It Take? Clinical Infectious Diseases. 2014;59(1):31-33.
    22. Pond MJ, Nori AV, Witney AA, Lopeman RC, Butcher PD, Sadiq ST. High Prevalence of Antibiotic-Resistant Mycoplasma genitalium in Nongonococcal Urethritis: The Need for Routine Testing and the Inadequacy of Current Treatment Options. Clinical Infectious Diseases. 2014;58(5):631-637.
  • Melanoma Updates

    By: Robin Gosdin Farrell, DNP, FNP-BC, Associate Clinical Professor, Auburn University College of Nursing

           Malignant melanoma occurs when melanocytes mutate and begin to spread. There are 3 predominate types of melanoma: cutaneous, ocular, and mucosal. Cutaneous melanoma (CM) is the most common type of melanoma and the 5th most common cancer diagnosed in the U.S. Cutaneous melanoma accounts for about 1% of all skin cancers but is responsible for most skin cancer deaths with a projected continual increase in incidence over the next decade.1 The diagnosis of CM is often made because of the high visibility of skin lesions. However, CM can also be found below fingernails, where it is called subungual melanoma. Skin cancer risk factors include exposure to ultraviolet (UV) light from the sun or tanning beds where excessive exposure over time is noted. Other risk factors include increasing age, atypical or many moles, large congenital moles (birthmarks), and personal or family history of melanoma.

           Mucosal melanoma (MM) is rare and originates from melanocytes within sun-protected mucous membranes. Compared to CM, MM is always internal, it has a poorer prognosis and there are no effective treatment options.  Mucosal melanoma is found in the mouth, nasal cavity and sinus passages, intestines, vagina, and anus.2 Symptoms vary based on the location and treatment, but usually involves surgical excision and prevention of recurrence.    

           Ocular melanoma (OM), the rarest form of melanoma. It is also known as uveal melanoma because of its growth in the uvea, a layer of tissue under the sclera. Ocular melanoma is the most common form of eye cancer with approximately 2,000 cases diagnosed annually in the U.S.3 Individuals at higher risk for OM are those with light skin, blonde or red hair, and blue eyes. Tumor growth can cause floating black spots, light flashes, or loss of eyesight and can often change the shape of the pupil. Approximately 50% of patients with OM will develop metastases within 10 to 15 years of diagnosis.3

           Melanoma is difficult to treat due to quick and aggressive metastases, multiple mutations during the growth of the tumor, and tumors that are often surrounded with dormant or exhausted T-cells.4 These characteristics have led to new treatments like immunotherapy,5 which at present has a high success rate. Outcomes also improve when treatment plans include combinations of immunosuppressive medications.

           Two checkpoint inhibitor drugs that utilize proteins in the body and are involved with generation of cell activation have been approved. These proteins include programmed death cell protein 1 (PD-1) and its ligand (PD-L1) and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4).6 Combinations can also target specific DNA features such as the BRAF gene, the BRAF protein, and the MEK pathway. Located on chromosome 7, the BRAF gene plays a role in cell growth by transmitting signals outside of the cell to the cell’s nucleus. Mitogen-activated protein kinase (MEK or MAPK) is involved in signal transduction pathways that modulate physiological and pathological cell responses.7 Despite a high side effect profile that includes fatigue, liver inflammation, thyroid issues, and others, combination immunotherapy will improve outcomes among patients being treated for skin cancer over the long haul.5


    1. American Cancer Society. (2019, August 14). About melanoma skin cancer. What is melanoma skin cancer? https://www.cancer.org/cancer/melanoma-skin-cancer/about/what-is-melanoma.html
    2. American Academy of Ophthalmology (2022). What is ocular melanoma? https://www.aao.org/eye-health/diseases/what-is-ocular-melanoma
    3. Aim at Melanoma Publications (2022). What is mucosal melanoma? https://www.aimatmelanoma.org/melanoma-101/types-of-melanoma/mucosal-melanoma/
    4. National Cancer Institute at the National Institutes of Health. (2020, August 25). Melanoma treatment. https://www.cancer.gov/types/skin/patient/melanoma-treatment-pdq
    5. American Cancer Society (2022, March 22). Immunotherapy for melanoma skin cancer. https://www.cancer.org/cancer/melanoma-skin-cancer/treating/immunotherapy.html
    6. National Cancer Institute (2021, June 21). Nivolumab and Relatlimab combination shows promise in advanced melanoma. https://www.cancer.gov/news-events/cancer-currents-blog/2021/melanoma-nivolumab-relatlimab-immunotherapy
    7. Pavlick, A., Zhao, R., Lee, C., Ritchings, C., & Rao, S. (2021). First-line immunotherapy versus targeted therapy in BRAF-mutant malignant melanoma: A real-world analysis. Future Oncology, 17(6), 689-699. https://doi.org/10.2217/fon-2020-0643
No thanks, just take me to the Exhibit Hall.