Plaque-Type Psoriasis Treated with Calcipotriene Plus Betamethasone Dipropionate Aerosol Foam: A Prospective Study on Clinical and Dermoscopic Predictor Factors in Response Achievement and Retention

Introduction: Little information on possible local factors that can influence the achievement and retention of response of plaque-type psoriasis to calcipotriene plus betamethasone dipropionate aerosol foam is available. The aim of this study was to assess possible correlations between baseline clinical/dermoscopic features of psoriatic plaques and therapeutic response, and between residual dermoscopic findings in clinically improved/healed lesions and post-treatment relapse. Methods: For each target lesion, we calculated the local psoriasis severity index and assessed dermoscopic findings at baseline and at the end of a 4-week treatment, correlating the therapeutic outcome with the initial clinical and dermoscopic features. The lesions were also followed for a 4-week post-treatment period, and possible associations between relapse and (1) baseline clinical/dermoscopic features and (2) dermoscopic findings detected at the end of the treatment were assessed. Results: A total of 105 lesions from 35 patients were included in the analysis. After 4\ua0weeks of therapy, 13 lesions showed no/limited improvement, while partial and optimal response were observed in 51 and 41 plaques, respectively. Poor outcomes were correlated with both legs localization\ua0and degree of lesion infiltration at baseline. Similarly, presence of globular vessels at baseline dermoscopy was more commonly associated with no/limited response and lesions on the legs, particularly those showing resistance to treatment. A correlation was also found between dotted vessels on the baseline dermoscopic examination and good outcomes (partial/optimal response). After a 4-week post-treatment follow-up, 58.7% of the lesions achieving improvement at the end of the therapy showed relapse, with a correlation between recurrence and vessel persistence\ua0on dermoscopy at the end of the therapy. Conclusion: Clinical response of plaque-type psoriasis to calcipotriol/betamethasone dipropionate spray foam may be adversely affected by the degree of infiltration of lesions at baseline and by legs\ua0localization, and the presence of globular vessels at the baseline dermoscopic assessment is related to poor outcomes. A significant post-treatment relapse rate was observed, and persistence of vascular changes on dermoscopy seems to play a role in promoting disease recurrence

How can we improve antidepressant adherence in the management of depression? A targeted review and 10 clinical recommendations.

Adherence to antidepressants is crucial for optimal treatment outcomes when treating depressive disorders. However, poor adherence is common among patients prescribed antidepressants. This targeted review summarizes the main factors associated with poor adherence, interventions that promote antidepressant adherence, pharmacological aspects related to antidepressant adherence, and formulates 10 clinical recommendations to optimize antidepressant adherence. Patient-related factors associated with antidepressant non-adherence include younger age, psychiatric and medical comorbidities, cognitive impairment, and substance use disorders. Prescriber behavior-related factors include neglecting medical and family histories, selecting poorly tolerated antidepressants, or complex antidepressant regimens. Multi-disciplinary interventions targeting both patient and prescriber, aimed at improving antidepressant adherence, include psychoeducation and providing the patient with clear behavioral interventions to prevent/minimize poor adherence. Regarding antidepressant choice, agents with individually tailored tolerability profile should be chosen. Ten clinical recommendations include four points focusing on the patient (therapeutic alliance, adequate history taking, measurement of depressive symptoms, and adverse effects improved access to clinical care), three focusing on prescribing practice (psychoeducation, individually tailored antidepressant choice, simplified regimen), two focusing on mental health services (improved access to mental health care, incentivized adherence promotion and monitoring), and one relating to adherence measurement (adherence measurement with scales and/or therapeutic drug monitoring)

Increased C-reactive protein concentration and suicidal behavior in people with psychiatric disorders: A systematic review and meta-analysis

Objective: Suicide is a leading cause of death worldwide. Identifying factors associated with suicidality (suicidal ideation [SI]/suicidal behavior) could increase our understanding of the pathophysiological underpinnings of suicide and improve its prevention. Methods: We conducted a systematic review (PubMed/PsycInfo/Cochrane databases, up to September 2020) and random-effect meta-analysis including observational studies comparing peripheral C-reactive protein (CRP) levels in suicidal versus non-suicidal patients affected by any psychiatric disorder and healthy controls (HC). Primary outcome was the CRP standardized mean difference (SMD) between patients with high suicidality versus those with absent or low suicidality. Secondary outcomes were SMD of CRP levels between those with suicide attempt versus no suicide attempt, as well as between those with (high) versus low or absent SI. Quality of included studies was measured with Newcastle-Ottawa scale. Results: Out of initial 550 references, 21 observational studies involving 7682 subjects (7445 with mood disorders or first-episode psychosis, 237 HC) were included. A significant association of CRP levels with suicidality (SMD 0.688, 95% CI 0.476–0.9, p < 0.001) emerged. CRP levels were higher in individuals with high SI (SMD 1.145, 95% CI 0.273–2.018, p = 0.010) and in those with suicide attempt (SMD 0.549, 95%CI 0.363–0.735, p < 0.001) than non-suicidal individuals (either patients or HC). Main analyses were confirmed in sensitivity analysis (removing HC), and after adjusting for publication bias. The cross-sectional design of included studies, and the high heterogeneity of diagnosis and treatment limit the generalizability of these results. Median quality of included studies was high. Conclusion: CRP is associated with higher suicidality in patients with mental disorders. Large cohort studies longitudinally monitoring CRP levels are needed to explore its longitudinal association with suicidality

Efficacy of colchicine in addition to anakinra in patients with recurrent pericarditis

Aim Anakinra, an anti IL-1 agent targeting IL-1 alfa and beta, is available for the treatment of recurrent pericarditis in cases with corticosteroid dependence and colchicine resistance after failure of conventional therapies. However, it is unclear if the combination with colchicine, a non-specific inhibitor of the inflammasome targeting the same inflammatory pathway of IL-1, could provide additional benefit to prevent further recurrences. The aim of the present observational study is to assess whether the addition of colchicine on top of anakinra could prolong the time to first recurrence and prevent recurrences better than anakinra alone. Methods International, all-comers, multicentre, retrospective observational cohort study analysing all consecutive patients treated with anakinra for corticosteroid-dependent and colchicine-resistant recurrent pericarditis. The efficacy endpoint was recurrence rate and the time to the first recurrence. Results A total of 256 patients (mean age 45.0±15.4 years, 65.6% females, 80.9% with idiopathic/viral aetiology) were included. 64 (25.0%) were treated with anakinra as monotherapy while 192 (75.0%) with both anakinra and colchicine. After a follow-up of 12 months, 56 (21.9%) patients had recurrences. Patients treated with colchicine added to anakinra had a lower incidence of recurrences (respectively, 18.8% vs 31.3%; p=0.036) and a longer event-free survival (p=0.025). In multivariable analysis, colchicine use prevented recurrences (HR 0.52, 95% CI 0.29 to 0.91; p=0.021). Conclusions The addition of colchicine on top of anakinra treatment could be helpful to reduce recurrences and prolong the recurrence-free survival

Dialogo alle soglie dell'inverosimile

La pubblicazione propone una conversazione immaginaria con Francesco Milizia. L’occasione consente di sviluppare una riflessione sui temi del processo costruttivo, della sua evoluzione storica, evidenziando la presenza all’interno di tale processo, di costanti strutturali di carattere storico

MITI DI OGGI

Il contributo propone una lettura delle matrice concettuale che sta alla base delle strutture museali realizzate dalla famiglia Guggenheim L’occasione consente di evidenziare il rapporto tra manufatto edilizio, funzione, valore simbolico e prestazione

Identità e architettura il culto interrotto. Problemi di recupero delle chiese nel territorio pisano.

Il lavoro affronta il tema delle architetture ecclesiastiche toscane dismesse al culto e di quali possano essere le modalità per una possibile azione di recupero

Rosignano la città della Solvay

Il volume analizza lo sviluppo dell’insediamento industriale tardo paternalistico di Rosignano Solvay. Lo studio pone in evidenza come la manualistica architettonica di fine Ottocento abbia rappresentato le basi per lo sviluppo edilizio negli anni successivi, e come questa abbia influito positivamente sull’arte dell’edificare, facendo sì che a distanza di quasi un secolo l’edificato presenti caratteristiche in grado di rispondere senza sostanziali cambiamenti al modo di vivere contemporaneo

The factory and the chimney symbol, function and restoration. The old textile mills in Friuli. Why should they be restored?

Lo studio analizza l’evoluzione dell’industria tessile friulana nel quadro dello sviluppo economico dell’epoca. In particolare lo studio si sofferma poi su particolari elementi funzionali (la ciminiera) che sono diventati veri e propri simboli rappresentativi di un periodo storico