Objective Woringer-Kolopp disease (WKD), also known as localized pagetoid reticulosis, is a rare variant of mycosis fungoides as described by the World Health Organization-European Organization for Research and Treatment of Cancer (WHO-EORTC) classification system for cutaneous lymphomas. Our objective was to conduct a comprehensive review that describes and evaluates patient demographics, clinical presentation, immunohistochemical findings, management, and outcomes of WKD. Methods The databases PubMed, Embase, and Cochrane Library were searched for relevant literature. Patient demographics, imaging, treatments, and other clinical characteristics were obtained. The literature search was conducted on December 7, 2020.Studies were included if they contained primary data related to WKD. Non-pertinent studies, non-English studies, non-human studies, review articles, or studies with insufficient case information were excluded. The quality of the included studies and the risk of bias were evaluated using the Grades of Recommendation, Assessment, Development, and Evaluation Group (GRADE) criteria ( 2016), Oxford Centre for Evidence-Based Medicine: Levels of Evidence (OCEBM) (March 2009), and the Methodological Index for Non-Randomized Studies (MINORS) criteria (2003).Results A total of 84 studies with 143 patients met the inclusion criteria for this study. The most common chief complaint was an asymptomatic, slow-growing, and erythematous plaque. The average time from initial skin eruption to presentation was 97.6 months.Histologically, 128 cases of WKD displayed epidermotropism (97.7%). Various therapies, including radiotherapy, surgery, and local chemotherapy, were used. In total, 92 (78.6%) cases had complete remission and 11 (9.4%) cases recurred. Conclusions WKD is a rare cutaneous T-cell lymphoma that often presents as a single plaque on the extremities with an indolent course and a favorable prognosis. However, it is often misdiagnosed, leading to delays in treatment. The diagnosis of WKD involves clinical appraisal, a biopsy of suspicious lesions, and immunohistochemistry. Monotherapy appears to be preferred compared to combination therapy for WKD with radiotherapy demonstrating among the highest cure rates and lowest recurrence. Future retrospective and prospective studies are needed to accurately determine the epidemiology, prognosis, and effective treatments for WKD. Limitations include a possibility of missed studies, heterogeneity in reporting methods, publication, and selection bias.What is already known about this topic?• Woringer-Kolopp disease (WKD) is a rare variant of mycosis fungoides as described by the World Health Organization-European Organization for Research and Treatment of Cancer (WHO-EORTC) classification system for cutaneous lymphomas.• Qualitative systematic analysis can generate new insights compared to individual findings.What does this study add?• Demonstrates the need for accurate diagnosis of Cutaneous T-Cell Lymphomas.

Introduction: Arab Americans are significantly affected by depression with prevalence as high as 50%. Our study assesses whether unique causes of depression such as stress, acculturation, and heritage identity play a role in the high prevalence of depression in Arab Americans. Methods: We surveyed 142 self-identified Arab Americans using a convenience model. Participants answered questions about their level of perceived stress, everyday discrimination, and acculturative stress. They also answered questions regarding their level of acculturation and heritage identity. Finally, participants answered questions regarding their depressive symptoms. A score of 16+ on the depression scale was used as the cut-off for depression. Results: The prevalence of depression in our sample was 60%. In our logistic regression model adjusted for age, sex, BMI and education, we found that perceived stress (OR = 1.21, 95% CI 1.10, 1.33, p < 0.01) and acculturative stress (OR = 1.02, 95% CI 1.00, 1.05, p < 0.05) were associated with greater odds of having depression in Arab Americans. We did not find that everyday discrimination, acculturation, or heritage identity were associated with depression in Arab Americans (p > 0.05). Conclusions: Our study shows that perceived stress and acculturative stress increase the odds of depression in Arab Americans and therefore may play a role in the high prevalence of depression in this population. We hope our findings inform clinicians on the important underlying causes that may be causing depression in their Arab American patients.

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Peripheral artery disease (PAD) is a significant cause of morbidity and mortality in the world. Critical limb ischemia is a complication of PAD that leads to severe pain at rest, numbness, and absent or diminished pulses in the legs or feet. Revascularization with surgery or endovascular intervention is required to reestablish blood flow to the affected areas. Failure to respond to medical and/or surgical treatment can lead to amputations. The decision to amputate one's limb can be very challenging. Here, we report a patient with critical limb ischemia who refused a below-the-knee amputation and self-treated with medicinal leech therapy, or hirudotherapy. His symptoms including his pain, burning, and numbness improved significantly following six months of therapy.