Dermatología en Costa Rica

Friday, August 30, 2019

Marijuana y Embarazo ... NO!

Surgeon General Warns About Marijuana's Effects on Young Brains

By Kelly Young

Edited by William E. Chavey, MD, MS

U.S. Surgeon General Jerome Adams is warning about the dangers that marijuana poses to the developing brains of youth and fetuses.

In an advisory released Thursday, he writes: "No amount of marijuana use during pregnancy or adolescence is known to be safe. Until and unless more is known about the long-term impact, the safest choice for pregnant women and adolescents is not to use marijuana."

The percentage of pregnant women who said they had used marijuana in the past month doubled between 2002 and 2017 (from 3.4% to 7%). In 2017, over 9 million young people aged 12 to 25 said they had used marijuana in the past month.

The Surgeon General says that frequent marijuana use during adolescence is tied to brain changes related to memory, attention, decision-making, and motivation. Fetal exposure is linked to disruption of the endocannabinoid system and lower birth weight.

Surgeon General's advisory (Free)

HHS news release (Free)

Background: NEJM Journal Watch Women's Health coverage of marijuana use in pregnancy (Free)


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Ojo THS

Nearly All Types of Menopausal Hormone Therapy Tied to Higher Breast Cancer Risk

By Amy Orciari Herman

Edited by William E. Chavey, MD, MS

All types of menopausal hormone therapy (HT), except vaginal estrogen, are associated with increased breast cancer risk, according to a large meta-analysis in the Lancet.

Researchers examined prospective data on over 100,000 postmenopausal women who developed breast cancer. Among the other findings:

  • Excess risk for breast cancer was greater for estrogen-progestogen combinations than for estrogen-only formulations.
  • Breast cancer risk increased with duration of HT use, but among current users, risk was elevated even during the first 4 years of use (for example, 1–4 years of estrogen-progestogen was associated with a 60% increased risk relative to nonuse).
  • Increased breast cancer risk persisted more than 10 years after stopping HT.

Dr. Andrew Kaunitz will take a closer look at these findings in NEJM Journal Watch Women's Health. Be on the lookout for his coverage.

Lancet article (Free abstract)

Background: NEJM Journal Watch Women's Health coverage of the safety of vaginal estrogen in menopause (Your NEJM Journal Watch registration required)


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Presión negativa en Heridas.

Published in Dermatology

Journal Scan / Research · August 30, 2019

Silver-Impregnated Negative-Pressure Wound Therapy for the Treatment of Lower-Extremity Open Wounds

Advances in skin & wound care

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Abstract 

OBJECTIVE

To investigate the antibacterial efficacy of silver-impregnated negative-pressure wound therapy (NPWT) in lower-extremity acute traumatic wounds.

METHODS

Open contaminated wounds caused by high-velocity trauma in the lower extremities were randomly allocated into two groups. The wounds in the control and experimental groups were treated with conventional NPWT (n = 31) and silver-impregnated NPWT (n = 35), respectively.

MAIN OUTCOME MEASURES

Serial bacterial cultures were obtained from the participants' wounds, polyurethane foam, and suction tubes weekly during the 4-week follow-up to identify bacteria and follow their conversions.

MAIN RESULTS

Bacterial colonization rates in the silver NPWT group were generally lower than those in the conventional NPWT group, and the difference increased with time. For methicillin-resistant Staphylococcus aureus colonization, wounds treated with silver-impregnated NPWT showed a significant reduction in bacterial load compared with those treated with conventional NPWT.

CONCLUSIONS

Silver-impregnated NPWT effectively decreases bacterial load in open contaminated wounds of the lower extremities. It can be used as a temporizing measure to manage bacterial colonization while patients and wounds are being prepared for final wound reconstruction

Advances in skin & wound care

Silver-Impregnated Negative-Pressure Wound Therapy for the Treatment of Lower-Extremity Open Wounds: A Prospective Randomized Clinical Study

Adv Skin Wound Care 2019 Aug 01;32(8)370-377, HM Hahn, IJ Lee, KJ Woo, BY Park 


Wednesday, August 28, 2019

Fototerapia niños

Finding Joy in pediatric phototherapy

DII small banner

By Warren R. Heymann, MD 
Aug. 28, 2019
Vol. 1, No. 25

heymann-warren-95px.jpgThis commentary is dedicated to Joy, a bright, rambunctious, delightful bundle of energy with (formerly) recalcitrant atopic dermatitis, who taught me a great deal about phototherapy in children. 

The cutaneous effects of ultraviolet (UV) light are by immunosuppressive, immunomodulating, and anti-inflammatory activities. Mechanisms of action include targeting of immunomodulation via apoptosis of inflammatory cells, inhibition of Langerhans cells, and alteration of cytokine production. Additionally, UV has an antimicrobial effect reducing the colonization of Staphylococcus aureus, due to its anti-inflammatory effect and improvement of the skin barrier. Other mechanisms could be due to the effects of Vitamin D metabolism and suppression of TH2 cytokines. (1)

The most commonly utilized form of phototherapy is narrowband UVB (NBUVB) because of its wide availability and lower risk of adverse effects. (2) In children NBUVB is generally considered as second-line therapy for patients with atopic dermatitis (AD), psoriasis, pitryriasis lichenoides chronica, prurigo nodularis, and vitiligo, who have had inadequate responses to standard topical agents such as steroids and calcineurin inhibitors. Eustace et al performed a retrospective review of 75 patients aged 3 to 17 years (mean 10.6 years; 35 male and 40 female) who received phototherapy. Forty-eight (64%) patients had AD and 21 (28%) had psoriasis. Seventy received NBUVB treatment and 5 received hand and foot psoralen with ultraviolet A (PUVA) treatment. All patients with AD were treated with NBUVB and 4 (8.3%) were also treated with hand PUVA. After phototherapy, 76% had documented clear to almost clear skin. At the 12-month follow-up, 52% of the patients with AD remained clear. All 21 patients with psoriasis underwent NBUVB phototherapy. The clearance rate after phototherapy was 86%. At the 12-month follow-up, 43% of the patients with psoriasis remained clear. (3)

According to Crall et al: "Short-term risks of UVB phototherapy include erythema, blistering, and xerosis, accompanied by pruritus, photosensitive eruptions, and recurrent herpes simplex virus infections. Provoking anxiety is another potential risk and should be discussed. Long-term risks include photo-aging and cutaneous carcinogenesis. The true carcinogenic potential in children remains unclear." (4)

There are unique considerations when offering phototherapy to pediatric patients. Is the child able to stand in the unit for several minutes unattended without touching the lights? Is the child's behavioral temperament and development mature enough to cooperate with treatment sessions? Does the child have claustrophobia or separation anxiety? (3,4) Absolute contraindications to phototherapy include both acquired and inherited disorders aggravated by ultraviolet light, such as lupus erythematosus, dermatomyositis, xeroderma pigmentosum, porphyrias, and the basal cell nevus syndrome. (4)

Although I look forward to when dupilumab is available for AD down to age 2 years, that is unlikely to happen presently. I have grown comfortable with the use of biologics, and have no qualms about using etanercept or ustekinumab, the two agents approved for children with psoriasis. For severe AD, I prefer not to use potent immunosuppressive agents such as cyclosporine or mycophenolate mofetil, if at all possible. Despite the inconvenience of administering phototherapy, and the relative dearth of studies in the pediatric population, I believe that it is truly the second-line approach of choice in recalcitrant cases. 

When Joy came for her first phototherapy session, she was impossibly anxious and frightened by the prospects of havingJoy to wear protective eyewear and fearing that she could not stand alone in our NBUVB phototherapy unit. It took every ounce of my long-since-gone memory of cajoling a child to cooperate. Somehow singing the alphabet together helped. I asked her to recite it when in the box to see how far she could go, and, maybe with practice, even do it backwards! Somehow, with each treatment, she became a little less nervous, where she is now at the point of actually enjoying it. Her AD is under great control too. Yesterday, when I saw her, I asked "So how is my girlfriend today?" "I'm not your girlfriend!" she howled. "I'm your patient who likes you very much!" It does not get better than that. 

Point to remember: Narrowband UVB therapy is a valuable therapy for children with recalcitrant dermatoses, such as atopic dermatitis and psoriasis. 


Our expert's viewpoint

Howard B. Pride, MD

I agree — I am a big fan of nbUVB in children. I will sometimes have parents go in fully dressed for the first couple of treatments if there is a great deal of anxiety and maybe not shut the door all the way. I am a big user of home UVB if I can get an insurer to pay for it. Our Geisinger Health Plan has been very receptive given that just a few big wins with home UVB will prevent money lost on a biological agent. 

1. Wollenberg A, Barbarot S, Bieber T, Christen-Zaech S, et al. Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: Part I. J Eur Acad Dermatol Venereol 2018; 657-682. 
2. Awasthi S, Rothe MJ, Eichenfield LF. Atopic dermatitis. Clin Dermatol 2015; 33: 594-604. 
3. Eustace K, Dolman S, Alsharqi A, Sharpe G, Parslew R. Use of phototherapy in children. Pediatr Dermatol 2017; 34: 150-155.
4. Crall CS, Rork JF, DeLano S, Huang JT. Phototherapy in children: Considerations and indications. Clin Dermatol 2016; 633-639. 

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Tuesday, August 27, 2019

Ctc’s Melanoma

Biotech Innovations 
August 13, 2019

Detecting Circulating Tumor Cells Through the Skin

JAMA. 2019;322(6):495. doi:10.1001/jama.2019.11240

Today's methods of detecting circulating tumor cells (CTCs) in blood are hampered by poor sensitivity, which limits the so-called liquid biopsies' usefulness for catching low-level CTCs present before metastasis, when prognosis is better. A new photoacoustic liquid biopsy approach that peers through the skin was more sensitive than existing assays in detecting CTCs in patients with melanoma.

Image description not available.
Yulian Menyaev, PhD/University of Arkansas for Medical Sciences

Researchers led by Vladimir Zharov, PhD, DSc, of the University of Arkansas for Medical Sciences in Little Rock, described their platform, called the Cytophone, in Science Translational Medicine. Laser pulses delivered to veins through the skin heated the melanin in melanoma cells, producing telltale acoustic waves picked up by an ultrasound transducer.

The method directly detected CTCs in 27 of 28 people with melanoma, with no false-positives in the cancer-free control group. The findings were confirmed with 6 ex vivo methods. In comparison, existing assays can detect circulating tumor cells in less than 40% to 60% of patients with cancer.

The new technique took just 10 to 20 seconds to find tumor cells in the bloodstream of patients with higher CTC concentrations; those with lower levels required 15 to 60 minutes of monitoring. Ultimately, the approach was able to detect as few as 1 CTC per liter of blood, making it up to 1000 times more sensitive than other liquid biopsies, according to the authors.

Different acoustic patterns also identified circulating blood clots, which can block blood vessels and are a major cause of cancer-related death. The technique also appeared to destroy CTCs in some patients, a finding confirmed in vitro.


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Friday, August 23, 2019

Ojo MTX

Subcutaneous Methotrexate May Be Superior To Oral Methotrexate In Treatment Of Chronic Plaque Psoriasis, Study Indicates

Dermatology Advisor (8/22) reports, "Subcutaneous...methotrexate (MTX) offers higher efficacy, faster results, fewer adverse effects, and lower relapse rates than oral MTX in treatment of chronic plaque psoriasis," research indicated. The findings of the 28-adult study were published online in Dermatologic Therapy.


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Wednesday, August 21, 2019

Amigdalitis crónica y psoriasis.

Agosto 12, 2019

Tonsillitis and pediatric psoriasis: Cohort and cross-sectional analyses of offspring from the Danish National Birth Cohort

Jonathan Groot, Christoffer Blegvad et al.
J Am Acad Dermatol. 2019 Aug 12 [Epub ahead of print]
BACKGROUND Streptococcal tonsillitis has been implicated in psoriasis; however, few population studies have examined its role in the pediatric population.

OBJECTIVE To investigate the association between tonsillitis and pediatric psoriasis METHODS: Data from the Danish National Birth Cohort were obtained on parentally reported psoriasis by age 11 years and history of tonsillitis at ages 6 - 18 months, 10 - 11 years, and (from hospital patient registry data) 0 - 11 years. We estimated odds ratios (ORs) and 95 % Confidence Intervals (CIs) of pediatric psoriasis using logistic regression analyses.

RESULTS In total, 35 188 offspring were eligible for analyses. Tonsillitis at 6 - 18 months was not associated with pediatric psoriasis (adjusted OR 0.73, 95 % CIs 0.47-1.14), nor was recent tonsillitis at ages 10 - 11 years (adjusted OR 1.09, 95 % CI 0.81-1.47). However, recurrent tonsillitis between ages 10 - 11 was strongly associated with pediatric psoriasis (adjusted OR 2.28, 95 % CIs 1.17-4.48). Our results for streptococcal tonsillitis indicated a potential association (adjusted OR 2.12, 95 % CIs 0.86, 5.17).

LIMITATIONS It was not possible to clarify the temporal relationship between tonsillitis and pediatric psoriasis CONCLUSION: Recurrent tonsillitis is of clinical relevance to pediatric psoriasis.

SOURCE : Journal of the American Academy of Dermatology

Libre de virus. www.avast.com

Monday, August 19, 2019

16 libros que debemos leer...

Reading is a daily habit commonly practiced by high achievers because it's an effective method of sharpening oneself. While nonfiction is the genre which likely comes to mind when it comes to self-improvement, even nonfiction is good for broadening your perspective and ability to be creative. Here are more than a dozen good titles to check out, according to successful executives who offer their rationales for reading them.

1. The Culture Code: The Secrets of Highly Successful Groups by Daniel Coyle

"While this isn't your typical, run-of-the-mill, motivational self-help read, [this book] breaks down how to create and maintain motivated cultures. Most entrepreneurs and professionals in leadership positions are pretty self-motivated, but fostering that motivation throughout an entire organization is often where the difficulty lies. Coyle starts with big ideas and dials them into systems, justifying them all with case studies. He defines three key skill sets successful cultures share: building safety, sharing vulnerability, and establishing purpose. He clarifies organizational challenges we all face, like 'status management,' and breaks them down to their essence to be overcome. Using case studies from the Navy SEALs to the San Antonio Spurs to elementary school students, he demonstrates both successes and failures in cultures, and, more importantly, the 'why' behind them. I found it to be an informative and inspiring read on one of the most important motivational topics any leader faces--building culture."

--Kelechi Okere, EVP of business development at RSP Nutrition, a nutrition brand distributed at retailers such as Amazon, Bodybuilding.com, GNC, and Vitamin Shoppe, in over 5,000 U.S. retail locations and over 80 countries

2. The Daily Stoic: 366 Meditations on Wisdom, Perseverance, and the Art of Living by Ryan Holiday and Stephen Hanselman 

"The most valuable books I've read in my life are those that help me shape the principles that underpin the way I live my life, as opposed to practical business advice. [This book] is the perfect guide to Stoicism, a school of philosophy which, at its root, is a philosophy for minimizing the negative emotions in your life and maximizing your gratitude and joy. Working for a fast-paced startup for the past four years, you encounter just about every emotion you can in business. Practicing Stoicism helps you remain leveled throughout the highs and lows. Remaining leveled mentally is an underrated characteristic of leaders, and in times of uncertainty, people will always seek support from the calmest person in the room."

--Cathal Berragan, U.S. creative director at The Social Chain, an integrated social-media company with clients including Amazon, Coca-Cola, Nokia, DreamWorks, and Disney

3. Essentialism: The Disciplined Pursuit of Less by Greg McKeown

"There are so many distractions in business today--so many people trying to convince you that they have the next thing that will take your business to the next level. It is important to not let these people and tactics distract you from what works. [This book] is an evergreen reminder of the fact that the basics in business still work, and work well if you focus on them. In the book, Greg renames the CEO from Chief Executive Officer to Chief Editing Officer, which is how I see myself when I step into a new business to lead its turnaround so that we can sell it for a multiple of revenue in one to two years. I need to edit out all the nonessential stuff for my team so that they are focused on revenue generating activities. The thing about being a Chief Editing Officer is that it is a never-ending job. You always need to be distilling the focus of yourself and your team into what matters most."

--Chris Dominello, director of business development at Reliefband Technologies, which offers patented, FDA-cleared, wearable technology that treats motion sickness through neuromodulation and is available at retailers such as SamsClub.com, Amazon, and FSAStore.com

4. How to Be a Friend to a Friend Who's Sick by Letty Cottin Pogrebin

"Shortly after undergoing a major surgery, I stumbled upon this book and have read it several times since. There is no manual on how to navigate life with a colleague, friend, or family member who is sick, yet this comes very, very close. This book makes you think about the ways in which you can improve your communication. Most people don't know how to approach so many situations as it relates to illness and this book provides valuable tips on how to navigate this. Letty has been the patient, caregiver, and friend, as well as interviewed many patients for the book, so she tackles all angles necessary to write about this topic. It's extremely heartwarming, tactical, and valuable for anyone who is looking to become more compassionate."

--Harper Spero, host of the Made Visible podcast, which has featured guests including Ally Hilfiger, Genevieve Gorder, and Gunnar Esiason, with sponsors including Lola, Beekeeper's Naturals, NDOband, and Ouchie

5. The Hard Thing About Hard Things by Ben Horowitz

"For anyone starting a company or thinking about it, they need to read this book. Startups aren't for the faint of heart, and Ben does a great job describing the personal and professional sacrifices [involved in them]. He also explains that startups are messy, full of mistakes, and even big ones have many near-death experiences where not making next payroll is very real. There's nothing that can prepare a startup founder better than jumping in the deep end. Future founders should take his messages literally and see if they have the fortitude and guts. 'The struggle is real,' and this book is a great wake-up call for the startup world."

--Patrick O'Leary, founder and CEO of Boostr, a media-specific CRM and order management platform which grew more than 250 percent last year

6. Unbroken by Laura Hillenbrand

"This book is about Louis Zamperini, a problem teenager, college athlete, Olympian, WWII airman, and Japanese POW. While he experienced countless achievements throughout his life, the book hones in on the most challenging of all, surviving Japanese entrapment. It's a testament to the overwhelming power of the human mind and body to overcome desperate times and events. Not only is it an enticing read, but it also shows what you can really do if you put your mind to something and don't let others or outside factors break you."

--Michael Fox, vice president and chief commercial officer at Valid, a global provider of technology solutions for mobile, identity, data, and payments that is the fifth-largest producer of SIM Cards in the world, and is among the world's 10 largest manufacturers of banking cards

7. The Road Less Stupid by Keith J. Cunningham

"Most entrepreneurs are going 100 miles per hour in dozens of different directions, but most of us don't even take five minutes of quiet time to think and plan. At the very start of the book, Cunningham asks: 'How much money would you have right now if I gave you the ability to unwind any three financial decisions you have ever made?' We all have great ideas, but sometimes the best successes are the mistakes we didn't make. Cunningham's book is full of insightful concepts, and I have seen tangible results from an amazingly simple one--set aside thinking time every day to work out all the variables and consequences in your plan so as to avoid those mistakes." 

--Avi Weintraub, Fort Lauderdale chair of Tiger 21, a peer membership organization with more than 700 high-net-worth wealth creators and preservers worldwide, and CEO of The Weintraub Companies, an Inc. 500 construction company

8. Feck Perfuction by James Victore

"My Stevie award-winning sister sent me [this] book... [T]he main theme: action over perfection. Everything about your life is a test of your character. From obstacles in front of you, to the fear inside you, to the naysayers beside you. Success is how you tackle these tests. And it's all up to you whether you play the victim or the hero. The imperfect actions of the hero are far greater than the inaction of the victim. It comes down to fighting to find the light, by being resourceful and breaking through to the other side of your greatness, and most importantly influencing your employees and colleagues."

--Lori Taylor, co-CEO of Better Choice Company, a global health and wellness business for animals, serving 150,000 customers with 62,000 product shipments per month 

9. The 5 a.m. Club by Robin Sharma

"I live this methodology. I wake up at 4:45 a.m. and I am in the gym by 5:00 a.m. The mental clarity and focus that owning the morning provides me sets my day up for success. It gives me the opportunity to work through my thoughts and goals for the day to ensure I make every day a meaningful and productive one. The routine provides me with discipline that radiates throughout all aspects of my professional life."

--Ryan Webber, VP of enterprise mobility at SOTI, a provider of mobile and IoT device management solutions, with more than 17,000 enterprise customers and millions of devices managed worldwide

10. The Art of War by Sun Tzu

"Written 2,500 years ago, this book is of a disconcerting pragmatism. Far from dogmas, principles, or ideologies, the objective of this book is to give readers the information that they need to win. On the one hand, it's a great manual for managers that advises leaders on humbleness, integrity, and an inflexible fairness. On the other, it provides the keys to intelligence, observation, and analysis for various cases so that leaders can act in a timely, composed manner. During my entrepreneurial life [this book] has always been a reliable source for me to look to during countless situations. It's a must-read."

--Dr. André Choulika, CEO of Cellectis, a publicly traded biopharma company that recently received approval from the U.S. FDA to initiate clinical trials with UCARTCS1 for the treatment of multiple myeloma with the first off-the-shelf CAR T-cell therapy

11. Blitzscaling: The Lightning-Fast Path to Building Massively Valuable Companies by Reid Hoffman and Chris Yeh

"As an entrepreneur, I am always interested in how to take my company to the next level. [This book] is the secret to take a company from one to one billion as quickly as possible and truly stand out from the competitors. This book cites the stories of the rapid rise of great companies of Facebook, Netflix, and Airbnb. The tools to support successful 'Blitzscaling' are the right business model, right hiring and managing practice, evolving culture, and marriage of responsibility and velocity for the greater good."

--Dr. Lan Huang, co-founder, chairman, and CEO at BeyondSpring, a late-stage biopharma company focused on developing cancer therapies for non-small cell lung cancer and for the prevention of chemotherapy-induced neutropenia, which recently raised $35 million during a public offering of ordinary shares 

12. Leveling the Playing Field: A Guide to Successful Business Development Transactions for Private and Small Public Life Science Companies by Larry Horowitz and Larry Ellberger

"This book is short, step-by-step analysis of how to approach negotiations, auctions, and development transactions. Both of the authors have immense experience and share it in a straightforward and honest read. While the book did not impact my personal life, it certainly provided me with a wealth of knowledge that has enabled more successful negotiations and better commercial outcomes. I would highly recommend it."

--Dr. William Levine, chief scientific officer of CannRx, a company developing scientifically-based cannabis technologies and products, and founder of Izun Pharmaceuticals, a company specializing in botanical medicine with an IP portfolio of over 65 patents

13. Grit: The Power of Passion and Perseverance by Angela Duckworth

"This is the book you need to read to realize that perseverance is probably the most important factor required to succeed both in business and in life, and may be more important than natural aptitude. The author illustrates through many examples how the power of interest, passion, and perseverance move people and ideas forward. I can really identify with this book's message: 'believe in your passion, identify a goal, and persevere through grit.' Grit is really all about the reaction to getting knocked down again and again, and how success is achieved by learning from failure. In the book: 'To be gritty is to fall down seven times and rise eight.' I really cannot count how many times I have been down face first. A couple times not even sure I would be able to get up again. But I always seem to, and most times move forward after the knockdown with a better understanding of what I have to do to succeed. To me, this is really the essence of being gritty."

--Dr. Paul MacKoul, co-founder of The Center for Innovative GYN Care, a surgical practice with five practice locations in four states, treating complex gynecologic conditions with trademarked, minimally invasive surgical techniques 

14. Alchemy by Rory Sutherland

"So many of us are trained to focus on data and the logical, and Alchemy makes a great argument for the irrational. I think everyone, myself specifically, could use a reminder that asking dumb questions, reframing old ideas, and, in turn, trying to create a bit of magic, can lead to unexpected solutions for some of our most difficult problems. Alchemy was a reminder of that and then some."

--Daniel Kane, co-founder and CEO of The Ridge, an accessories company that makes a front-pocket wallet that has been purchased by more than 1 million people globally

15. Start with Why by Simon Sinek

"I was recently recommended this book and absolutely devoured it, and then immediately re-read it. The main concept, as told by Sinek, is that 'People don't buy what you do, they buy why you do it.' Although it is an admittedly challenging task, being able to articulate why your company is doing whatever it's doing--and not just what it sells--is really powerful and helps to drive decision making with much more clarity. This book gives you the framework to better develop and more clearly express your 'Why.'" 

--Adam Callinan, co-founder and CEO of BottleKeeper, which earned a $1 million combined offer from Mark Cuban and Lori Greiner on Shark Tank in November 2018

16. Cancer Ward by Aleksandr Solzhenitsyn

"I read this great classic by the Nobel prize winner Solzhenitsyn when I was in graduate school. [This book] is best known for its brilliant macro insights of Soviet life at the depth of the Cold War in the 1950s and micro insights of an individual confronting death. The story is told through characters representing different aspects of Soviet life, from the ex-political prisoner who survived years in the brutal gulags to the Soviet official who ratted out non-communists. For me, the inspirational aspect of the book was the change of behavior of a young cancer victim, who first entered the clinic with a stack of books he was committed to reading. As he realized his plight, his motivation was replaced with despair. Remarkably, he survives, but his outlook on life dramatically changes. Solzhenitsyn brilliantly addresses how life changes our motivations and how we view the world."

--Dr. Jonathan Rothbard, chief scientific officer at cannabis biotech CannBioRx Life Sciences Corp., who was responsible for helping to establish a variety of successful biotech companies, including Amylin Pharmaceuticals (acquired by Bristol-Myers Squibb in 2012 for $7 billion), ImmuLogic, CellGate, and Cardinal Therapeutics

Published on: Aug 18, 2019
The opinions expressed here by Inc.com columnists are their own, not those of Inc.com.

Tratamiento intralesional de verrrugas recalcitrantes

ublished in Dermatology

Journal Scan / Research · August 18, 2019

Intralesional vs Intramuscular Bivalent HPV Vaccine in the Treatment of Recalcitrant Common Warts

Journal of the American Academy of Dermatology

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Friday, August 16, 2019

Eritema multiforme en niños.

Published in Dermatology

Journal Scan / Review · August 11, 2019

Triggers, Clinical Manifestations, and Management of Pediatric Erythema Multiforme

Journal of the American Academy of Dermatology

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Rituximab para penfigo en Niños

Rituximab Therapy in Pediatric Pemphigus Patients

Pediatric Dermatology

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