Clinical practice guidelines for the prevention and treatment of EGFR inhibitor-associated dermatologic toxicities

Background Epidermal growth factor receptor inhibitors (EGFRI) produce various dermatologic side effects in the majority of patients, and guidelines are crucial for the prevention and treatment of these untoward events. The purpose of this panel was to develop evidence-based recommendations for EGFRI-associated dermatologic toxicities. Methods A multinational, interdisciplinary panel of experts in supportive care in cancer reviewed pertinent studies using established criteria in order to develop first-generation recommendations for EGFRI-associated dermatologic toxicities. Results Prophylactic and reactive recommendations for papulopustular (acneiform) rash, hair changes, radiation dermatitis, pruritus, mucositis, xerosis/fissures, and paronychia are presented, as well as general dermatologic recommendations when possible. Conclusion Prevention and management of EGFRI-related dermatologic toxicities is critical to maintain patients’ health-related quality of life and dose intensity of antineoplastic regimens. More rigorous investigation of these toxicities is warranted to improve preventive and treatment strategies

Capillary Malformation-Arteriovenous Malformation Syndrome: A Report of 2 Cases, Diagnostic Criteria, and Management.

Capillary malformation-arteriovenous malformation syndrome is a rare type of vascular malformation first described in 2003. It is an autosomal dominant inherited disorder that has been reported in association with heterozygous mutations in the RASA1 gene, which encodes the protein RASp21. The clinical picture is characterized by multiple small capillary malformations which are associated with either arteriovenous malformations or arteriovenous fistulas in both the affected individual and other members of their family. We describe 2 new familial cases of this syndrome that were clinically and genetically diagnosed and studied in our hospital

Supplementary Material for: Acute Severe Methotrexate Toxicity in Patients with Psoriasis: A Case Series and Discussion

<p><b><i>Background:</i></b> Methotrexate (MTX) is considered a relatively safe drug when prescribed at low-dose regimens not exceeding 25 mg/week. Severe acute toxicity is rare and presents with mucositis, cutaneous ulceration and pancytopenia. Most cases occur as the result of inadvertent overdosing due to erroneously taking the drug daily. However, concomitant factors such as older age, co-medication and renal failure may increase the drug's toxicity. <b><i>Case Reports:</i></b> We report four consecutive cases of acute MTX toxicity in patients with psoriasis vulgaris. In three patients, MTX was erroneously taken daily for 2-4 weeks. All three patients recovered following MTX withdrawal and intensive treatment. The fourth patient was taking 7.5 mg weekly MTX as prescribed, but had concomitant factors and died. <b><i>Conclusion:</i></b> Although low-dose MTX appears to be a safe medication, acute MTX toxicity can be a life-threatening emergency. Greater awareness of possible MTX toxicity is still needed for its prevention, early diagnosis and management.</p

Efficient Bacteria Inactivation by Ultrasound in Municipal Wastewater

The reuse of treated wastewaters could contribute to reducing water stress. In this research, ultrasound application on bacterial inactivation in municipal wastewater (MWW) was evaluated. Total and fecal coliforms were used as standard fecal indicators; volatile suspended solids (VSS) were analyzed too. Samples were taken from the effluent of secondary clarifiers. In addition, inactivation tests were carried out on pure cultures of E. coli (EC) and B. subtilis (BS). Sonication was performed at 20 kHz, 35% amplitude and 600 W/L for 15, 30 and 45 min. After 15 min of sonication, bacterial density was reduced by 1.85 Log10 MPN/100 mL for EC and 3.16 Log10 CFU/mL for BS. After 30 min, no CFU/mL of BS were observed in MWW and, after 45 min, the reduction of total and fecal coliforms was practically 6.45 Log10 MPN/100mL. Inactivation mechanism was made by cavitation, which causes irreversible damage to the cell wall. Although high bacterial densities were employed, percentages of inactivation &gt;99% were reached at 45 min. This research contributes to the implementation of ultrasound as a disinfection technique with high potential due to its high efficiency without producing byproducts. In fact, the water meets the guidelines for reuse in direct human contact services

Emotion processing in joint hypermobility: A potential link to the neural bases of anxiety and related somatic symptoms in collagen anomalies

BACKGROUND: Joint hypermobility syndrome (JHS) has repeatedly been associated with anxiety and anxiety disorders, fibromyalgia, irritable bowel syndrome and temporomandibular joint disorder. However, the neural underpinnings of these associations still remain unclear. This study explored brain responses to facial visual stimuli with emotional cues using fMRI techniques in general population with different ranges of hypermobility. METHODS: Fifty-one non-clinical volunteers (33 women) completed state and trait anxiety questionnaire measures, were assessed with a clinical examination for hypermobility (Beighton system) and performed an emotional face processing paradigm during functional neuroimaging. RESULTS: Trait anxiety scores did significantly correlate with both state anxiety and hypermobility scores. BOLD signals of the hippocampus did positively correlate with hypermobility scores for the crying faces versus neutral faces contrast in ROI analyses. No results were found for any of the other studied ROIs. Additionally, hypermobility scores were also associated with other key affective processing areas (i.e. the middle and anterior cingulate gyrus, fusiform gyrus, parahippocampal region, orbitofrontal cortex and cerebellum) in the whole brain analysis. CONCLUSIONS: Hypermobility scores are associated with trait anxiety and higher brain responses to emotional faces in emotion processing brain areas (including hippocampus) described to be linked to anxiety and somatic symptoms. These findings increase our understanding of emotion processing in people bearing this heritable variant of collagen and the mechanisms through which vulnerability to anxiety and somatic symptoms arises in this population

Efficient Malathion Removal in Constructed Wetlands Coupled to UV/H2O2 Pretreatment

Intensive agriculture has led to the increasing application of pesticides, such as malathion, thus generating large volumes of untreated cropland wastewater (CropWW). In this work, a hybrid system constructed wetlands (CW) coupled in continuous with an optimized UV/H2O2 pretreatment was evaluated for the efficient removal of malathion contained in CropWW. In the first stage, 90 min UV irradiation time (UV IR) and 65 mM hydrogen peroxide (H2O2) were identified as optimal operation parameters through a central composite design. The second stage consisted of CW planted with Phragmites australis collected from the agricultural discharge area and operated as a piston flow reactor. Furthermore, CW hydraulic residence times (HRT) of 1, 2 and 3 days, including hydraulic coupling, were evaluated. The removal efficiencies obtained in the first stage (UV/H2O2) were 94 &plusmn; 2.5% of malathion and 45 &plusmn; 2.5% of total organic carbon (TOC). In stage two (CW) 65 &plusmn; 9.6% TOC removal was achieved during the first 17 days, from which around 24% was associated to the biosorption of malathion byproducts. Subsequently, and until the operation ends, CW removed about 80% of TOC for 2 and 3 days HRT, with no significant differences (p &gt; 0.2), which is higher than those reported in several studies involving only advanced oxidation processes (AOP) with UV IR times above 240 min and even for systems using catalysts. The results obtained indicate that the system UV/H2O2-CW is a technically suitable option for the treatment of CropWW with a high content of malathion mainly found in developing countries. Moreover, the hybrid system proposed also represent significant reduction in the size of the treatment plant

Supplementary Material for: Anti-Tumour Necrosis Factor-Induced Visceral and Cutaneous Leishmaniasis: Case Report and Review of the Literature

<b><i>Background:</i></b> Leishmaniasis is a chronic protozoan disease in which organisms are found within phagolysosomes of the mononuclear phagocyte system. There are three major forms: cutaneous, mucocutaneous and visceral. We report the first case of visceral leishmaniasis with cutaneous involvement in a patient with rheumatoid arthritis treated with the anti-tumour necrosis factor (anti-TNF) adalimumab. <b><i>Objective:</i></b> To highlight cutaneous leishmaniasis as the first indicator of a kala-azar disease in a patient treated with anti-TNF and to review the literature on leishmaniasis in the context of anti-TNF therapy. <b><i>Case Report:</i></b> A 59-year-old woman presented with a crusted plaque on the right elbow 34 months after the initiation of adalimumab. A cutaneous biopsy showed intracellular amastigotes. No <i>Leishmania</i> parasites were observed in a bone marrow aspirate, but laboratory tests showed anaemia and impaired liver function, abdominal ultrasonography showed hepatomegaly, and ELISA serology was strongly positive for <i>Leishmania</i> antibodies in serum and urine. Adalimumab was withdrawn and treatment combining intralesional pentavalent antimonials and liposomal amphotericin was started. Eight weeks later, the leishmaniasis had resolved. <b><i>Conclusion:</i></b> A skin biopsy disclosing leishmaniasis should prompt tests to rule out visceral leishmaniasis, especially in an area such as the Mediterranean where the prevalence of latent <i>Leishmania</i> infection is high