Gianotti-Crosti syndrome and allergic background

The aim of the study was to verify whether there is a relationship between Gianotti-Crosti syndrome and an allergic background in children. Twenty-nine children affected by Gianotti-Crosti syndrome were first screened for a large panel of microbiological examinations, including serological and cultural tests for viruses and bacteria. A causative agent was identified in only 10 cases (34.4%). In five cases a diagnosis of Epstein—Barr virus infection was made on the basis of significant titres of anti-Epstein-Barr virus antibodies (IgM) associated with constitutional symptoms (fever, pharyngitis ‐ tonsillitis). Our data concur with several clinical studies demonstrating that Epstein-Barr virus is now the most common viral agent associated with Gianotti-Crosti syndrome. For allergic evaluation, a group of 59 age- and sex-matched children investigated for recurrent infections were used as controls. The presence of atopic dermatitis (24.1% )i n those with Gianotti-Crosti syndrome was significantly higher (pv0.005) than in the control group (6.8%). In addition, a more common family history for atopy was 51.7% vs. 31% (pv0.027) and the percentage of patients with total IgE greater than +2 SD for age higher than in controls (27.6% vs. 13.7%), as was the percentage of specific IgE present (31% vs. 17.2%). These results indicate that atopy is significantly associated with Gianotti-Crosti syndrome. Key words: acrodermatitis; atopic dermatitis; infantile papular eruption; allergy; Epstein-Barr virus

The surgical treatment of non-metastatic melanoma in a Clinical National Melanoma Registry Study Group (CNMR): a retrospective cohort quality improvement study to reduce the morbidity rates

Background: Reproducible, high-quality surgery is a key point in the management of cancer patients. Quality indicators for surgical treatment of melanoma has been presented with benchmarks but data on morbidity are still limited. This study presents the quality indicators on morbidity after surgical treatment for non-metastatic skin melanoma in an Italian registry. Methods: Data were extracted from the Central National Melanoma Registry (CNMR) promoted by the Italian Melanoma Intergroup (IMI). All surgical procedures (WE, SNLB or LFND) for non-metastatic skin melanoma between January 2011 and February 2017 were evaluated for inclusion in the study. Only centers with adequate completeness of information (> 80%) were included in the study. Short-term complications (wound infection, dehiscence, skin graft failure and seroma) were investigated. Results: Wound infection rate was 1.1% (0.4 to 2.7%) in WE, 1.3% (0.7 to 2.5%) in SLNB and 4.1% (2.1 to 8.0%) in LFND. Wound dehiscence rate was 2.0% (0.8 to 5.1%) in WE, 0.9% (0.2 to 3.0%) in SLNB and 2.8% (0.9 to 8.6%) in LFND. Seroma rate was 4.2% (1.5 to 11.1%) in SLNB and 15.1% (4.6 to 39.9%) in LFND. Unreliable information was found on skin graft failure. Conclusions: Our findings contribute to available literature in setting up the recommended standards for melanoma centers, thus improving the quality of surgery offered to patients. A consensus on the core issues around surgical morbidity is needed to provide practical guidance on morbidity prevention and management

A machine-learning based bio-psycho-social model for the prediction of non-obstructive and obstructive coronary artery disease

Background: Mechanisms of myocardial ischemia in obstructive and non-obstructive coronary artery disease (CAD), and the interplay between clinical, functional, biological and psycho-social features, are still far to be fully elucidated. Objectives: To develop a machine-learning (ML) model for the supervised prediction of obstructive versus non-obstructive CAD. Methods: From the EVA study, we analysed adults hospitalized for IHD undergoing conventional coronary angiography (CCA). Non-obstructive CAD was defined by a stenosis < 50% in one or more vessels. Baseline clinical and psycho-socio-cultural characteristics were used for computing a Rockwood and Mitnitski frailty index, and a gender score according to GENESIS-PRAXY methodology. Serum concentration of inflammatory cytokines was measured with a multiplex flow cytometry assay. Through an XGBoost classifier combined with an explainable artificial intelligence tool (SHAP), we identified the most influential features in discriminating obstructive versus non-obstructive CAD. Results: Among the overall EVA cohort (n = 509), 311 individuals (mean age 67 ± 11 years, 38% females; 67% obstructive CAD) with complete data were analysed. The ML-based model (83% accuracy and 87% precision) showed that while obstructive CAD was associated with higher frailty index, older age and a cytokine signature characterized by IL-1β, IL-12p70 and IL-33, non-obstructive CAD was associated with a higher gender score (i.e., social characteristics traditionally ascribed to women) and with a cytokine signature characterized by IL-18, IL-8, IL-23. Conclusions: Integrating clinical, biological, and psycho-social features, we have optimized a sex- and gender-unbiased model that discriminates obstructive and non-obstructive CAD. Further mechanistic studies will shed light on the biological plausibility of these associations. Clinical trial registration: NCT02737982

Acute Delta Hepatitis in Italy spanning three decades (1991–2019): Evidence for the effectiveness of the hepatitis B vaccination campaign

Updated incidence data of acute Delta virus hepatitis (HDV) are lacking worldwide. Our aim was to evaluate incidence of and risk factors for acute HDV in Italy after the introduction of the compulsory vaccination against hepatitis B virus (HBV) in 1991. Data were obtained from the National Surveillance System of acute viral hepatitis (SEIEVA). Independent predictors of HDV were assessed by logistic-regression analysis. The incidence of acute HDV per 1-million population declined from 3.2 cases in 1987 to 0.04 in 2019, parallel to that of acute HBV per 100,000 from 10.0 to 0.39 cases during the same period. The median age of cases increased from 27 years in the decade 1991-1999 to 44 years in the decade 2010-2019 (p < .001). Over the same period, the male/female ratio decreased from 3.8 to 2.1, the proportion of coinfections increased from 55% to 75% (p = .003) and that of HBsAg positive acute hepatitis tested for by IgM anti-HDV linearly decreased from 50.1% to 34.1% (p < .001). People born abroad accounted for 24.6% of cases in 2004-2010 and 32.1% in 2011-2019. In the period 2010-2019, risky sexual behaviour (O.R. 4.2; 95%CI: 1.4-12.8) was the sole independent predictor of acute HDV; conversely intravenous drug use was no longer associated (O.R. 1.25; 95%CI: 0.15-10.22) with this. In conclusion, HBV vaccination was an effective measure to control acute HDV. Intravenous drug use is no longer an efficient mode of HDV spread. Testing for IgM-anti HDV is a grey area requiring alert. Acute HDV in foreigners should be monitored in the years to come

The Sex-Specific Detrimental Effect of Diabetes and Gender-Related Factors on Pre-admission Medication Adherence Among Patients Hospitalized for Ischemic Heart Disease: Insights From EVA Study

Background: Sex and gender-related factors have been under-investigated as relevant determinants of health outcomes across non-communicable chronic diseases. Poor medication adherence results in adverse clinical outcomes and sex differences have been reported among patients at high cardiovascular risk, such as diabetics. The effect of diabetes and gender-related factors on medication adherence among women and men at high risk for ischemic heart disease (IHD) has not yet been fully investigated.Aim: To explore the role of sex, gender-related factors, and diabetes in pre-admission medication adherence among patients hospitalized for IHD.Materials and Methods: Data were obtained from the Endocrine Vascular disease Approach (EVA) (ClinicalTrials.gov Identifier: NCT02737982), a prospective cohort of patients admitted for IHD. We selected patients with baseline information regarding the presence of diabetes, cardiovascular risk factors, and gender-related variables (i.e., gender identity, gender role, gender relations, institutionalized gender). Our primary outcome was the proportion of pre-admission medication adherence defined through a self-reported questionnaire. We performed a sex-stratified analysis of clinical and gender-related factors associated with pre-admission medication adherence.Results: Two-hundred eighty patients admitted for IHD (35% women, mean age 70), were included. Around one-fourth of the patients were low-adherent to therapy before hospitalization, regardless of sex. Low-adherent patients were more likely diabetic (40%) and employed (40%). Sex-stratified analysis showed that low-adherent men were more likely to be employed (58 vs. 33%) and not primary earners (73 vs. 54%), with more masculine traits of personality, as compared with medium-high adherent men. Interestingly, women reporting medication low-adherence were similar for clinical and gender-related factors to those with medium-high adherence, except for diabetes (42 vs. 20%, p = 0.004). In a multivariate adjusted model only employed status was associated with poor medication adherence (OR 0.55, 95%CI 0.31–0.97). However, in the sex-stratified analysis, diabetes was independently associated with medication adherence only in women (OR 0.36; 95%CI 0.13–0.96), whereas a higher masculine BSRI was the only factor associated with medication adherence in men (OR 0.59, 95%CI 0.35–0.99).Conclusion: Pre-admission medication adherence is common in patients hospitalized for IHD, regardless of sex. However, patient-related factors such as diabetes, employment, and personality traits are associated with adherence in a sex-specific manner

The Role of Photodynamic Therapy in the Treatment of Vulvar Intraepithelial Neoplasia

Background: vulvar intraepithelial neoplasia is a non-invasive precursor lesion found in 50–70% of patients affected by vulvar squamous cell carcinoma. In the past, radical surgery was the standard treatment for vulvar intraepithelial neoplasia, however, considering the psychological and physical morbidities related to extensive surgery, several less aggressive treatment modalities have been proposed since the late 1970s. Photodynamic therapy is an effective and safe treatment for cutaneous non-melanoma skin cancer, with favorable cosmetic outcomes. Methods: in the present paper, the results of selected studies on photodynamic therapy in the treatment of vulvar intraepithelial neoplasia are reported and discussed. Results: Overall, complete histological response rates ranged between 20% and 67% and symptom response rates ranged between 52% and 89% according to different studies and case series. Conclusions: the real benefit of photodynamic therapy in the setting of vulvar intraepithelial neoplasia lies in its ability to treat multi-focal disease with minimal tissue destruction, preservation of vulvar anatomy and excellent cosmetic outcomes. These properties explain why photodynamic therapy is an attractive option for vulvar intraepithelial neoplasia treatment

a long lasting verrucous plaque on the hand revealed as tuberculosis cutis

Sir, Histopathology showed marked hyperkeratosis and acanthopapillomatosis. A dense lymphocytic in® ltrate surTuberculosis verrucosa cutis (TVC) is a rare form of cutaneous tuberculosis due to inoculation of mycobacterium tuberculosis rounded small aggregatesof histiocytes and few multinucleated Langhan's type cells. There was no caseation necrosis. The (MT) into the skin of a subject with relatively high degree of immunity. We report here the case of a man with a longZiehl-Neelsen stain did not reveal any acid-fast bacilli and no MT-DNA was detected by PCR. Mycobacterial culture lasting hyperkeratotic, verrucous plaque on the back of his left hand, the nature of which had remained undiagnosed for performed using Middlebrook 7H9 solid medium showed the growth of small whitish-yellowish colonies which were identiup to 56 years. ® ed as MT complex using a speci® c DNA probe. The isolated strain was sensitive in vitro to rifampicin and streptomycin but CASE REPORT resistant to isoniazid and ethambutol. We decided to treat the patient with rifampicin 600mg/day and cipro oxacin A 74-year-old man was referred because of a long-lasting dermatosis involving the back of his left hand. He underwent 500mg/day. After a month of treatment, an evident improvement of the skin lesion was noted and after 8 months of a nephrectomy in 1994 for a clear cell carcinoma of the left kidney. The skin lesion had appeared as a small brown-reddish therapy the only ® ndings were an erythematous, welldemarcated, slightly in® ltrating plaque. ulcerated nodule at the site of a minor trauma in 1944, when he was a prisoner in a Nazi concentration camp in the former East Germany. Despite multiple topical treatments, including DISCUSSION corticosteroids, antibiotics and emollients, the initial lesion TVC represents a virulent exogenous infection of the skin in had slowly centrifugally extended, ending in a large, verrucous patients with a fairly high degree of immunity already sensitplaque. Clinical examination revealed an in® ltrating, oval, ized to MT complex (1). The inoculation of mycobacteria into erythematous-violet plaque, measuring 6 3 12 cm in diameter, the skin generally occurs throughminimalwounds or abrasions with a hyperkeratotic and warty surface (Fig. 1). No regional and the most frequently involved sites are hands, buttocks lymphadenopathy or extracutaneous involvement were and feet (2). For professional reasons, butchers, forensic detected. Abnormal laboratory ® ndings included the follscientists and pathologists are most often aŒected (3). The owing: red blood cell count 4.1 3 1012 /l (normal range disease is now rare in Western countries. Skin involvement 4.5± 6.5 3 1012 /l ), erythrocyte sedimentation rate 42mm/h usually consists of a single lesion presenting as a verrucous (0± 29mm/h), creatinin 2mg/dl (0.6± 1.4), uric acid 11mg/dl plaque with an in ammatory border and showing progressive, (3.5± 7.2) and triglycerids 215mg/dl (40± 160). Other routine slow peripheral extension. The verrucous surface often has laboratory values were normal. ® ssures from which a purulent material is discharged. The Chest X-ray was normal and abdomen ultrasound examinalesion sometimes undergoes a centralized regression, leaving a tion revealed only a mild sclerosis of liver tissue. The Mantoux whitish atrophic scar. Regional lymphadenitis is rare (4). test with 5 IU of tuberculin protein puri® ed derivative was On histologic examination, hyperkeratosis, acanthosis and strongly positive (>25mm in diameter) after 48 h. papillomatosis are seen in the epidermis. The presence of Three biopsy specimens from lesional skin were pergranulomatous in® ltrates is a cardinal sign. In TVC, which formed for histopathologic examination, mycobacterial and together with lupus vulgaris represents the paucibacillary form polymerase chain reaction (PCR) examination. of cutaneous tuberculosis,direct microscopywith special stains for acid-fast bacilli (Ziehl-Neelsen) and cultures may give negative results. In such cases con® rmation of a tubercular etiology is often supported by the improvement with antitubercular drugs (5). In the case reported here, the positive culture for MT gave strong support to the diagnosis, together with histopathological and clinical data. This is quite a rare ® nding, since tissue cultures from paucibacillary forms of cutaneous tuberculosis usually give negative results, as reported by most authors (6± 8). The role of PCR in the diagnosis of TVC is still uncertain, although according to some authors the detection of MT by PCR is highly sensitive and speci® c (9± 11). However, a recent retrospective study based on PCR detection of MT complex Fig. 1. Hyperkeratotic and warty plaque of the back of the hand. using routinely processed skin biopsy specimens from patient

Utility of electrochemotherapy in melanoma treatment

In the present study, the role of electrochemotherapy (ECT) in the advanced melanoma setting, either as alternative treatment modality to conventional therapies or as palliative care, is reviewed and the perspective to combine ECT with biological response modifiers and immunotherapeutic compounds is discussed. Recent findings ECT refers to the combination of electroporation and administration of anticancer drugs for local treatment of solid neoplasms. Electroporation uses short and intense electric pulses to induce a transient permeabilization of the cell membrane by creation of pores, thus allowing molecules, such as chemotherapeutic agents, to freely diffuse into the cytosol. ECT has shown to be effective and clinically well tolerated in the local control of primary and metastatic solid tumors of diverse histotypes in preclinical and clinical studies, thus, emerging as useful local treatment modality for disseminated superficial melanoma. So far, only a few data on the role of immunological response in ECT-treated patients have been reported. Summary Treatment regimens combining ECT to biological response modifiers (interleukin-2, interferon) and immunotherapeutic compounds should be further explored in animal and human cancer models; immunotherapy combined to ECT could broaden the therapeutic indications of ECT, by rendering it effective also on distant unreachable or untreated lesions

In Situ Melanoma of the Nipple and Areola: A Dermoscopic Report in Two New Cases

none4nono abstract requirednoneGiulio Tosti, Camilla Salvini, Alessia Barisani, Sabina VaccariGiulio Tosti, Camilla Salvini, Alessia Barisani, Sabina Vaccar