Anthropometric Features and Third-Fourth Degree Perineal Tears

The main objective of this study was to evaluate the association between maternal and fetal anthropometric characteristics and third- and fourth-degree perineal tears. This retrospective cohort study considered all consecutive pregnancies from 2011 to 2017 at a single Institution. The inclusion criteria were: singletons who delivered vaginally during the study period, the presence of information on maternal pre-pregnancy weight, maternal height, and weight of the newborn. The feto-maternal body-mass index (BMI) was calculated as neonatal weight in kg on maternal height in squared meters (kg/m(2)). In total, 5397 singleton-term pregnancies were included; the prevalence of third-fourth-degree perineal tears was 0.47%. The most predictive factors were: nulliparity, feto-maternal BMI, neonatal weight, gestational age at delivery, and neonatal head circumference. After adjustment in multivariate analysis, the only independent predictors were nulliparity and fetomaternal BMI. The AUC of the final multivariate model was 73.54% (95% CI 65.65-81.42). Furthermore, feto-maternal BMI and gestational age had a significant direct correlation. Nulliparity and feto-maternal BMI are the two best predictors for third and fourth-degree perineal tears in our setting. Confirming this association in future research and integrating it into a decision algorithm on delivery timing could reduce obstetric damage to the anal sphincter

Pediatric Old World cutaneous leishmaniasis treated with oral fluconazole: A case series

Background: Cutaneous leishmaniasis has an incidence of 0.7–1.2 million cases per year and represents a growing concern in the outpatient dermatologic practice in Europe because of imported cases due to increased travel to risk areas and to immigration phenomena. When dealing with children, the treatment can be challenging because of side effects and pain of classic antimonial therapy leading to poor rates of course completion and requirement of sedation for several children. Methods: We retrospectively studied three cases of cutaneous leishmaniasis in pediatric patients, between the ages of 3 and 6 years of age, treated with oral fluconazole. We examined the efficacy, the tolerability, the safety profile and the cosmetic result of fluconazole at a dose of 6 mg/kg/daily for 6 weeks. Results: The patients had a complete resolution of their lesions with minimal scarring. No adverse effect was reported. The leishmaniasis species identified were L. major or L. tropica. Conclusion: Considering sides effects and the parents’ and the clinician's concern for systemic treatment in the pediatric population, fluconazole represents a valid, safe and easily manageable option for Old World cutaneous leishmaniasis in pediatric outpatients caused by L. major or L. tropica

"Spiky/keratosis-pilaris-like early follicular mycosis fungoides: a clinicopathologic study of 20 cases with extended follow-up

Backgrounds: Follicular mycosis fungoides is a distinct form of T-cell lymphoma whose course is considered aggressive. Methods: a retrospective study with long-term follow-up of 20 patients diagnosed with spiky/keratosis-pilaris-like follicular mycosis fungoides between 2008 and 2017 was conducted. Results: 12 males and 8 females were identified, with a mean age at first diagnosis of 59 years (range 42-86). Hyperkeratotic follicular papules were the sole clinical finding in 16/20 patients. A diagnostic delay between first symptom development and initial diagnosis was frequent (mean 42 months). The head/neck region was concurrently affected only in 2 patients. Disease stage at diagnosis was IA in 2 patients (10%) and IB in 18 (90%). Five patients had almost complete lesion regression, whilst there was only a slight improvement, without regression in 14. Two patients developed infiltrated papules, comedones and small cysts during follow-up. Only 1 patient progressed to tumor stage (IIB) 5 years after first diagnosis. The mean follow-up was 7 years (range: 12-180 months). None of them died of cutaneous lymphoma. Conclusions: FMF presenting with only spiky/keratosis-pilaris-like lesions have an excellent prognosis at medium term follow-up. Early recognition of patients with this peculiar FMF presentation might lead to identify prognostic factors