Kaposi's sarcoma of the hand mimicking squamous cell carcinoma in a woman with no evidence of HIV infection: a case report

<p>Abstract</p> <p>Introduction</p> <p>Kaposi's sarcoma is a vascular neoplasm mainly affecting the skin of the lower extremities. Although it is the most common neoplasm affecting patients with AIDS, sporadic cases in HIV-negative people have been reported. It is a lesion mainly affecting men and its clinical presentation presents a challenge, as it can resemble other benign or malignant skin lesions.</p> <p>Case presentation</p> <p>We report a rare case of Kaposi's sarcoma presenting in a 68-year-old Mediterranean woman with no evidence of HIV infection. The patient had a 6-month history of a slowly progressing pigmented lesion on the dorsum of her left hand. The lesion clinically resembled a squamous cell carcinoma. The patient was treated with a wide excision of the lesion and primary reconstruction with a full thickness skin graft. Histopathological and immunohistochemical analysis of the excised lesion revealed the presence of Kaposi's sarcoma. Serologic investigation for HIV was negative but polymerase chain reaction for human herpes virus type 8 infection was positive. Thorough clinical and imaging investigation of the abdomen and chest were both negative for loci of disease.</p> <p>Conclusion</p> <p>Kaposi's sarcoma, although rare in its sporadic form, should be considered in the differential diagnosis of indeterminate skin lesions, especially those affecting the extremities.</p

The influence of isotretinoin and 5a-reductase inhibitors in metalloproteases of connective tissue in patients with acne

Acne Vulgaris is not a life threatening disease, but it has psychological and social consequences, of variant seriousness. There is a great variety of pharmaceutical substances and treatment strategies for acne, and among them, isotretinoin and 5-a reductase inhibitors are two of the most important. The aim of this thesis was the investigation of the influence of isotretinoin and of the 5-a reductase inhibitor, 5-AR Isocomplex, on matrix metalloproteases (MMPs) of the connective tissue of patients with acne. MMPs are enzymes of the extracellural matrix that play a key-role in the remodeling of the tissues after inflammation or wound. Thus, they are very important in the pathophysiology of acne, and the investigation of the influence of the two pharmaceutical substances on MMPs will contribute in the further understanding of their mechanism of action. More specifically, we investigated the influence of isotretinoin (per os or locally) in the expression of mRNA of MT-MMPs, or gelatinases and of TIMPs with the method of RT-PCR, in sebum specimens from 59 acne patients. Also, we investigated the influence of the per os treatment with isotretinoin on the activity of gelatinases in the plasma of 13 patients, with the method of gelatin zymography. Finally, the influence of the 5-a reductase inhibitor, 5-AR Isocomplex (with local treatment) on the activity of gelatinases and the protein levels of TIMPs, was investigated in the sebum of 20 acne patents with zymography and ELISA, respectively. The results have shown the statistically equal decrease of the enzyme activity levels of gelatinase MMP-9 in sebum, under the treatment with isotretinoin or 5-a reductase inhibitor, without any reduce in the levels of TIMPs, and with a subsequent clinical improvement. Thus, we realized that the pathophysiological action of MMP-9 in the extracellural matrix, which is the degradation of some important molecules aiming the histological integrity of skin, is inhibited with the action of isotretinoin and 5-a reductase inhibitor, with a subsequent improvement as concerns the clinical symptoms of the disease.Η κοινή ακμή δεν είναι μια απειλητική για τη ζωή ασθένεια, αλλά έχει ψυχοκοινωνικές επιπτώσεις, άλλοτε άλλης βαρύτητας, καθώς και ποικίλες μορφές και πορείες εξέλιξης. Υπάρχει μια ευρεία ποικιλία φαρμακευτικών ουσιών και θεραπευτικών στρατηγικών για την αντιμετώπιση της, ανάμεσα στις οποίες καίρια θέση κατέχουν η ισοτρετινοΐνη και οι αναστολείς της 5-α αναγωγάσης. Σκοπός της παρούσας έρευνας είναι η διεύρυνση της επίδρασης της ισοτρετινοΐνης και του αναστολέα της 5-α αναγωγάσης, 5-AR Isocomplex στις μεταλλοπρωτεάσες (MMPs) του συνδετικού ιστού σε ασθενείς με ακμή. Οι MMPs είναι ένζυμα της εξωκυττάριας ουσίας που παίζουν σημαντικό ρόλο στην αναδόμηση των ιστών μετά από τραύμα η φλεγμονή. Συνεπώς κατέχουν καίρια θέση στην παθοφυσιολογία της ακμής, και η διερεύνηση της επίδρασης των δύο μελετώμενων φαρμάκων σε αυτές θα βοηθήσει στην περαιτέρω κατανόηση του μηχανισμού δράσης τους. Συγκεκριμένα, μελετήθηκε η επίδραση της ισοτρετινοΐνης (per os ή τοπικά) στην έκφραση m RNS των MT MMPs, των ζελατινασών και των TIMPs, με την μέθοδο RT-PCR, σε δείγματα σμήγματος ακμής 59 ασθενών. Επίσης, μελετήθηκε η επίδραση της συστηματικά χορηγούμενης ισοτρετινοΐνης στην ενζυμική δραστηριότητα των ζελατινασών σε δείγματα πλάσματος 13 ασθενών, με τη μέθοδο της ζυμογραφίας ζελατίνης. Τέλος, διερευνήθηκε η επίδραση του αναστολέα της 5-α αναγωγάσης 5-AR Isocomplex, μετά από τοπική χορήγηση, στην ενζυμική δραστηριότητα των ζελατινασών και στα επίπεδα πρωτεΐνης των TIMPs, στο σμήγμα 20 ασθενών με ακμή, με τη μέθοδο της ζυμογραφίας και με ELISA, αντίστοιχα. Τα αποτελέσματα της μελέτης απέδειξαν την ελάττωση των επιπέδων και της ενζυμικής δραστηριότητας της ζελατινάσης MMP-9 στο σμήγμα, υπό την επίδραση, τόσο της ισοτρετινοΐνης, όσο και του αναστολέα της 5-α αναγωγάσης, χωρίς όμως, ταυτόχρονη ελάττωση των επιπέδων του αναστολέα των MMPs, TIMP-1, ενώ υπήρχε παράλληλη βελτίωση της κλινικής εικόνας. Συνεπώς, η παθογενετική δραστηριότητα της συγκεκριμένης ζελατινάσης στην εξωκυττάρια ουσία, μέσω της αποδόμησης διαφόρων, σημαντικών για την ιστολογική ακεραιότητα του δέρματος μορίων, ανεστάλη με την επίδραση των συγκεκριμένων φαρμάκων, γεγονός που προφανέστατα συνέβαλε και στη βελτίωση της κλινικής εικόνας

Information System for Symptom Diagnosis and Improvement of Attention Deficit Hyperactivity Disorder: Protocol for a Nonrandomized Controlled Pilot Study

BackgroundAttention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders during childhood; however, the diagnosis procedure remains challenging, as it is nonstandardized, multiparametric, and highly dependent on subjective evaluation of the perceived behavior. ObjectiveTo address the challenges of existing procedures for ADHD diagnosis, the ADHD360 project aims to develop a platform for (1) early detection of ADHD by assessing the user’s likelihood of having ADHD characteristics and (2) providing complementary training for ADHD management. MethodsA 2-phase nonrandomized controlled pilot study was designed to evaluate the ADHD360 platform, including ADHD and non-ADHD participants aged 7 to 16 years. At the first stage, an initial neuropsychological evaluation along with an interaction with the serious game developed (“Pizza on Time”) for approximately 30-45 minutes is performed. Subsequently, a 2-week behavior monitoring of the participants through the mADHD360 app is planned after a telephone conversation between the participants’ parents and the psychologist, where the existence of any behaviors characteristic of ADHD that affect daily functioning is assessed. Once behavior monitoring is complete, the research team invites the participants to the second stage, where they play the game for a mean duration of 10 weeks (2 times per week). Once the serious game is finished, a second round of behavior monitoring is performed following the same procedures as the initial one. During the study, gameplay data were collected and preprocessed. The protocol of the pilot trials was initially designed for in-person participation, but after the COVID-19 outbreak, it was adjusted for remote participation. State-of-the-art machine learning (ML) algorithms were used to analyze labeled gameplay data aiming to detect discriminative gameplay patterns among the 2 groups (ADHD and non-ADHD) and estimate a player’s likelihood of having ADHD characteristics. A schema including a train-test splitting with a 75:25 split ratio, k-fold cross-validation with k=3, an ML pipeline, and data evaluation were designed. ResultsA total of 43 participants were recruited for this study, where 18 were diagnosed with ADHD and the remaining 25 were controls. Initial neuropsychological assessment confirmed that the participants in the ADHD group showed a deviation from the participants without ADHD characteristics. A preliminary analysis of collected data consisting of 30 gameplay sessions showed that the trained ML models achieve high performance (ie, accuracy up to 0.85) in correctly predicting the users’ labels (ADHD or non-ADHD) from their gameplay session on the ADHD360 platform. ConclusionsADHD360 is characterized by its notable capacity to discriminate player gameplay behavior as either ADHD or non-ADHD. Therefore, the ADHD360 platform could be a valuable complementary tool for early ADHD detection. Trial RegistrationClinicalTrials.gov NCT04362982; https://clinicaltrials.gov/ct2/show/NCT04362982 International Registered Report Identifier (IRRID)RR1-10.2196/4018