Imatinib-associated hyperpigmentation, a side effect that should be recognized

Introduction & Objectives: Imatinib mesylate is a tyrosine-kinase inhibitor used as the first-line treatment in chronic myeloid leukemia patients who are not candidate for allogeneic bone marrow transplantation. The most frequently reported drug-related side effects are edema, nausea, vomiting, muscle cramps, musculoskeletal pain, diarrhea and rash. Imatinib treatment is often associated with hypopigmentation, but only a few cases of mucocutaneous hyperpigmentation are described in literature. We are reporting an additional case of mucocutaneous blue hyperpigmentation in a patient affected by chronic myeloid leukemia and treated with imatinib since 2003. Material & Methods: A review of the available literature regarding the hyperpigmentation related to imatinib was performed and one additional case was analysed. Results: In our case imatinib therapy was well tolerated for several years and it led to an excellent hematological and cytogenetic response. However, the patient gradually developed an intense blue hyperpigmentation that involved the oral mucosa and part of the skin. Other causes of hyperpigmentation were excluded. Conclusions: Since 2001, when imatinib was approved from Food and Drug Administration for chronic myeloid leukemia, some cases of secondary hyperpigmentation were reported. This rare side effect should be recognized by the physicians. Moreover, the patient should be informed about this benign event before starting the therapy. Currently, no treatment is required for this condition and there is not indication to discontinue imatinib treatment. Further insight into the mechanisms of the pigmentary alterations caused by this drug is suggested for better treatment and prevention of these manifestations

The association between insight and depressive symptoms in schizophrenia: Undirected and Bayesian network analyses

Background. Greater levels of insight may be linked with depressive symptoms among patients with schizophrenia, however, it would be useful to characterize this association at symptom-level, in order to inform research on interventions. Methods. Data on depressive symptoms (Calgary Depression Scale for Schizophrenia) and insight (G12 item from the Positive and Negative Syndrome Scale) were obtained from 921 community-dwelling, clinically-stable individuals with a DSM-IV diagnosis of schizophrenia, recruited in a nationwide multicenter study. Network analysis was used to explore the most relevant connections between insight and depressive symptoms, including potential confounders in the model (neurocognitive and social-cognitive functioning, positive, negative and disorganization symptoms, extrapyramidal symptoms, hostility, internalized stigma, and perceived discrimination). Bayesian network analysis was used to estimate a directed acyclic graph (DAG) while investigating the most likely direction of the putative causal association between insight and depression. Results. After adjusting for confounders, better levels of insight were associated with greater self-depreciation, pathological guilt, morning depression and suicidal ideation. No difference in global network structure was detected for socioeconomic status, service engagement or illness severity. The DAG confirmed the presence of an association between greater insight and self-depreciation, suggesting the more probable causal direction was from insight to depressive symptoms. Conclusions. In schizophrenia, better levels of insight may cause self-depreciation and, possibly, other depressive symptoms. Person-centered and narrative psychotherapeutic approaches may be particularly fit to improve patient insight without dampening self-esteem

POOR WELFARE DUE TO A RARE FUNGAL SKIN DISEASE

Among diseases caused by fungi (i.e. mycoses) dermatophytosis, cryptococcosis and aspergillosis are commonly reported in horses. Conversely, other mycoses are underestimated, often not suspected or diagnosed. This study presents a rare case of Geotricum spp dermatitis. After surgery and antibiotic treatment, a saddle horse (gelding, 11 year old) showed well-circumscribed areas of non-pruritic alopecia. The owner did not promptly call the veterinarian suspecting an allergic reaction. The horse lost more hair and weight; a veterinarian was consulted and corticosteroids were administered since an allergic reaction was suspected. At a different veterinarian examination (1 month later), the skin lesion had worsened with alopecia affecting the face, neck, circumferentially around the lower limbs and shoulders. Large white loosely adherent scale coated affected skin, with thick keratin-rich crusts adherent to the lower limbs. The horse was lethargic, pyretic (40 °C), heart and respiratory rates were increased, and hair was shedding/easily epilated, back legs were swollen, and yellow exudate could be expressed from a skin erosion on the knee. Examination of the blood revealed mild neutrophilia (leucocyte count 14.5 103/µl). Anti-inflammatory and antibiotics were administered. Hair, skin scraping and skin biopsy were collected. Routine diagnostic procedures for isolation of bacteria and ectoparasites were performed, but the sample was negative. A fungal infection was suspected and hair and skin scraping samples were examined microscopically using May Grunwald Giemsa method and cultured onto Sabouraud dextrose agar with chloramphenicol (0.4 mg/ mL), and cycloheximide (0.5 mg/mL). Identification was performed on the basis of macroscopic and microscopic features. Geotricum candidum was isolated. Impression smears were made from skin biopsy sample and hair samples and examined cytologically, after be fixed in methanol and stained with May Grunwald Giemsa. A clump of Geotrichum candidum was found; hyphae were branching, non-parallel walled, with septae. Stable disinfection and baths with local antifungal solution (Virkon S) were performed daily for three weeks, the diet was supplemented with vitamins C and E, the horse grazed at least 6 hours without a rug daily. At the 3 week follow up, the horse had gained weight, the alopecia was decreased, and clinical parameters were normal. The antifungal treatment was continued twice a week for three months. This study suggests G. candidum may cause skin lesions in horses after long-term use of corticosteroids or antibiotics. To ensure the principle of good health, in cases of dermatitis veterinarians should promptly be consulted, and appropriate diagnostic procedures should be carried out to reach a diagnosis

Imatinib-associated hyperpigmentation, a side effect that should be recognized

Introduction & Objectives: Imatinib mesylate is a tyrosine-kinase inhibitor used as the first-line treatment in chronic myeloid leukemia patients who are not candidate for allogeneic bone marrow transplantation. The most frequently reported drug-related side effects are edema, nausea, vomiting, muscle cramps, musculoskeletal pain, diarrhea and rash. Imatinib treatment is often associated with hypopigmentation, but only a few cases of mucocutaneous hyperpigmentation are described in literature. We are reporting an additional case of mucocutaneous blue hyperpigmentation in a patient affected by chronic myeloid leukemia and treated with imatinib since 2003. Material & Methods: A review of the available literature regarding the hyperpigmentation related to imatinib was performed and one additional case was analysed. Results: In our case imatinib therapy was well tolerated for several years and it led to an excellent hematological and cytogenetic response. However, the patient gradually developed an intense blue hyperpigmentation that involved the oral mucosa and part of the skin. Other causes of hyperpigmentation were excluded. Conclusions: Since 2001, when imatinib was approved from Food and Drug Administration for chronic myeloid leukemia, some cases of secondary hyperpigmentation were reported. This rare side effect should be recognized by the physicians. Moreover, the patient should be informed about this benign event before starting the therapy. Currently, no treatment is required for this condition and there is not indication to discontinue imatinib treatment. Further insight into the mechanisms of the pigmentary alterations caused by this drug is suggested for better treatment and prevention of these manifestations

3D reconstruction for preoperative planning of partial anomalous pulmonary venous return

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Rare Generalized Form of Fungal Dermatitis in a Horse: Case Report

A rare case of Geotrichum spp. dermatitis in a horse is presented. After unrelated, previous surgery and antibiotic treatment, a saddle horse showed well-circumscribed areas of non-pruritic alopecia. Suspecting allergic skin disease, the horse was treated with corticosteroids. The skin lesion spread, and a second veterinarian was consulted. At clinical examination, the horse was lethargic, pyretic and hair was shedding/easily epilated over the head, neck, shoulders, and legs and the hind legs were swollen. Blood analysis revealed mild leucocytosis and hyperglobulinemia. Hair, skin scraping, and skin biopsy ruled out parasites and bacteria; cytology identified yeast-like structures with hyphae or pseudohyphae. Geotrichum candidum was isolated on culture. Treatment consisted of stable disinfection, topical application of an antifungal solution, vitamins C and E supplementation and allowing the horse to graze in sunlight for at least 6 h/day. At 3-weeks follow-up, the horse had gained weight, alopecia was decreased, and all other clinical parameters were normal. Antifungal treatment was continued twice a week for three months. This study suggests Geotrichum candidum may cause skin lesions in horses after long-term use of corticosteroids or antibiotics. To avoid unnecessary and prolonged suffering in cases of dermatitis, veterinarians should be promptly consulted, appropriate diagnostic procedures conducted, so that a definitive diagnosis can be reached, and an appropriate treatment regimen implemented

A case of equine aspergillosi: A novel sampling procedure for diagnosis.

Aspergillus spp. may induce equine respiratory infections such as fungal pneumonia, guttural pouch mycosis, and systemic infection in immunocompromised individuals. This study describes a case of probable respiratory aspergillosis in a horse presenting clinical signs of the upper airway disease different from those previously reported. Nasopharyngeal swabs and guttural pouch centesis were performed, and Aspergillus flavus was isolated and identified. Following 30 days of pharmaceutical treatment with itraconazole, clinical signs resolved. Results suggested that aspergillosis should be included in the differential diagnosis of upper airway infections, guttural pouch centesis may be useful to make a correct diagnosis, and itraconazole is efficacious in the treatment of A flavus infection

Minimally Invasive Congenital Cardiac Surgery: A Large Volume European Experience

Background: In an effort to reduce postoperative trauma and achieve more cosmetic results, minimally invasive approaches to correct congenital heart anomalies have been recently proposed and increasingly adopted. Here we describe our experience for the past 23 years. Methods: Patients who underwent a surgical procedure between February 1996 and March 2019 with a minimally invasive approach for the correction of congenital heart disease in our center were included in this study. A statistical analysis was carried out to compare the results of the different minimally invasive techniques. A meta-analysis was conducted to compare our results in patients undergoing atrial septal defect repair with those from other groups. Results: There were 1002 patients included. A midline lower mini-sternotomy was performed in 45% of patients (n = 455), a right anterior mini-thoracotomy in 36% (n = 356) and a right lateral mini-thoracotomy in 19% (n = 191). The procedures were atrial septal defect repair (n = 575, 57%), ventricular septal defect repair (n = 218, 22%), and correction of atrioventricular defect (n = 82, 8%) or partial anomalous pulmonary venous return (n = 70, 7%). Post-cardiotomy syndrome was the most frequent complication (n = 40, 4%). No difference was observed between the approaches in terms of complications and peri-operative outcomes, and when these were compared with the results of other centers. Conclusions: Patients undergoing surgical repair of congenital heart disease through a minimally invasive approach have excellent outcomes, regardless of the approach used