Agreement on classification of clinical photographs of pigmentary lesions: exercise after a training course with young dermatologists.

Smartphone apps may help promoting the early diagnosis of melanoma. The reliability of specialist judgment on lesions should be assessed. Hereby, we evaluated the agreement of 6 young dermatologists, after a specific training. Clinical judgment was evaluated during 2 online sessions, 1 month apart, on a series of 45 pigmentary lesions. Lesions were classified as highly suspicious, suspicious, non-suspicious or not assessable. Cohen's and Fleiss' kappa were used to calculate intra- and inter-rater agreement. The overall intra-rater agreement was 0.42 (95% confidence interval - CI: 0.33-0.50), varying between 0.12-0.59 on single raters. The inter-rater agreement during the first phase was 0.29 (95% CI: 0.24-0.34). When considering the agreement for each category of judgment, kappa varied from 0.19 for not assessable to 0.48 for highly suspicious lesions. Similar results were obtained in the second exercise. The study showed a less than satisfactory agreement among young dermatologists. Our data point to the need for improving the reliability of the clinical diagnoses of melanoma especially when assessing small lesions and when dealing with thin melanomas at a population level

Telogen effluvium treated with Serenoa repens supplement

Telogen effluvium is a non-scarring form of hair loss. Clinically, the disease is characterized by hair loss where more than normalamounts of hair fall out; it usually affects the whole scalp in a widespread manner. When hair loss is very pronounced and persists fora long time, alopecia becomes clinically evident. It is not associated to subjective symptoms. In this paper, the authors describe theclinical case of a 67-year old patient suffering from telogen effluvium, treated with a supplement containing amino acids (L-cystineand L-methionine), vitamin E, iron and extract of Serenoa repens

Crural ulcers at lower limbs: Acquired or genetic pathology?

The authors report a case of a 50-year-old man with bilateral, wide, crural ulcers of 1-year duration on the lower limbs. The patient experienced 3 transient ischemic attacks (TIAs), and instrumental exams revealed thrombotic events involving the kidney, lung, and central nervous system (CNS). The authors performed a thrombophilic screening, which indicated altered concentrations of C and S proteins and antithrombin III (AT III) and a single-base mutation (C677T) at the methylene tetrahydrofolate reductase gene (MTHFR). Methylene tetrahydrofolate reductase gene mutation may be associated with a coagulation system disorder. These data suggest that the MTHFR mutation may be responsible for cutaneous ulcer pathogenesis

The impact of discrete versus continuous dimensions strategies in heroin and cocaine self-administration on drug-taking patterns and social interaction.

Background: During their drug-use history, cocaine and heroin users gain mastery and control over their drug consumption. Indeed, they self-regulate the dosage, route, speed, and frequency of administration as a function of the expected effects (e.g., avoid withdrawal, experiencing euphoria, etc.). Counterintuitively, most preclinical self-administration and choice procedures use discrete dimension strategies, featured by experimenter-imposed unit-doses interspersed by timeouts, which prevent the experimental animal to self-select the appropriate dose-time relationship of administration. Here, we contrasted discrete to continuous dimension strategies (i.e., self-selected doses without timeout) that allow to do so. Methods*: We analyzed the drug-taking patterns and modeled drug-brain levels (PK profiling) under distinct self-administration training conditions, featured by the presence or absence of time-out between consecutive drug injections. We further assessed the motivation to take and seek drugs across training conditions and in the context of drug-vs-social choice procedures. Results: The drug-taking patterns, and related PK profiling, were profoundly different across both training conditions and drug under examination. Continuous dimension strategy resulted in an increased heroin intake and promoted the emergency of drug-taking patterns characterized by the injection of spaced and large doses of drug, resulting in high and fast-rising brain levels of heroin. By contrast, cocaine intake was only slightly increased and there were no differences in the drug-taking patterns. Notably, we did not observe overdoses in rats trained without a timeout, contrary to what the literature would have anticipated. Rather, the lack of timeout was associated with stronger motivation to take and seek drugs. Finally, by employing a continuous dimension strategy we described, for the first time, social withdrawal after heroin, but not cocaine self-administration in rats. Conclusions: Here, we provide evidence advocating for the implementation of continuous, rather than discrete dimension strategies in self-administration and choice procedures because more accurately mirror human-drug-related behaviors (and likely the neural adaptations)

Treating psoriasis with etanercept in Italian clinical practice: Prescribing practices and duration of remission following discontinuation

Background: Conventional antipsoriatic therapies are often administered until remission, with treatment resumed in the case of relapse, in order to reduce the likelihood of cumulative, dose-dependent toxicities. Biological agents have been safely used in continuous therapy. Objective: To assess the use of etanercept for psoriasis in clinical practice in Italy. Methods: This was an observational study carried out in 13 dermatological centres across Italy in patients with plaque psoriasis (with a Psoriasis Area and Severity Index [PASI] score ≥10) treated with etanercept. The study comprised a treatment and subsequent discontinuation period. Patients were eligible if they had plaque psoriasis and had begun treatment with etanercept between 1 September 2007 and 1 April 2008. Patients were evaluable for the duration of discontinuation analysis if they achieved a PASI reduction ≥50% (PASI50) and a PASI score <10 at the end of treatment. Etanercept treatment was restarted if the PASI score reached ≥10 or the patient had a clinical relapse. Data were collected retrospectively up to June 2008 and prospectively between July 2008 and January 2009. Patients received etanercept during the treatment period, followed by no etanercept treatment (other psoriasis treatment permitted) during the discontinuation period, and etanercept again during re-treatment. The main outcome measures were: PASI scores (type A responders: PASI reduction ≥75% [PASI75]; type B responders: PASI50 and PASI final score <10), Dermatology Life Quality Index (DLQI) scores and body surface area (BSA) involvement. Time from discontinuation to retreatment was evaluated. Use of other antipsoriatic medications was recorded throughout. Results: Eighty-five patients were evaluable for the treatment period. Overall, 55 (64.7%) of these patients were prescribed etanercept 50mg twice weekly. The mean treatment duration was approximately 25 weeks. In total, 79 patients (92.9%) were considered type B responders and 77 of these patients were evaluable for the duration of discontinuation analysis. Overall, 68/85 (80%) were type A responders. During the treatment period, 7/85 (8.2%) patients received other antipsoriatic therapies. Improvements in mean DLQI score (-71.5%) and mean BSA involvement (-79.2%) were also observed. Etanercept was well tolerated. During the discontinuation period, 40/77 (51.9%) patients used other antipsoriatic medications (group 1) and 37/77 (48.1%) did not (group 2). The mean duration of discontinuation was significantly longer in group 1 (174 days) than in group 2 (117 days, log-rank test: p = 0.0013). Conclusion: In clinical practice, the duration of discontinuation from etanercept was in accordance with previously reported data, and was longer in patients who received other antipsoriatic drugs during discontinuation of etanercept than in those who did not. High rates of PASI50 and PASI75 response were obtained with etanercept, and these rates were higher than those observed in controlled clinical studies. Etanercept treatment was flexible, effective and well tolerated, and was associated with improved quality of life. © 2010 Adis Data Information BV. All rights reserved

Treating psoriasis with etanercept in Italian clinical practice: Prescribing practices and duration of remission following discontinuation

Background: Conventional antipsoriatic therapies are often administered until remission, with treatment resumed in the case of relapse, in order to reduce the likelihood of cumulative, dose-dependent toxicities. Biological agents have been safely used in continuous therapy. Objective: To assess the use of etanercept for psoriasis in clinical practice in Italy. Methods: This was an observational study carried out in 13 dermatological centres across Italy in patients with plaque psoriasis (with a Psoriasis Area and Severity Index [PASI] score 6510) treated with etanercept. The study comprised a treatment and subsequent discontinuation period. Patients were eligible if they had plaque psoriasis and had begun treatment with etanercept between 1 September 2007 and 1 April 2008. Patients were evaluable for the duration of discontinuation analysis if they achieved a PASI reduction 6550% (PASI50) and a PASI score <10 at the end of treatment. Etanercept treatment was restarted if the PASI score reached 6510 or the patient had a clinical relapse. Data were collected retrospectively up to June 2008 and prospectively between July 2008 and January 2009. Patients received etanercept during the treatment period, followed by no etanercept treatment (other psoriasis treatment permitted) during the discontinuation period, and etanercept again during re-treatment. The main outcome measures were: PASI scores (type A responders: PASI reduction 6575% [PASI75]; type B responders: PASI50 and PASI final score <10), Dermatology Life Quality Index (DLQI) scores and body surface area (BSA) involvement. Time from discontinuation to retreatment was evaluated. Use of other antipsoriatic medications was recorded throughout. Results: Eighty-five patients were evaluable for the treatment period. Overall, 55 (64.7%) of these patients were prescribed etanercept 50mg twice weekly. The mean treatment duration was approximately 25 weeks. In total, 79 patients (92.9%) were considered type B responders and 77 of these patients were evaluable for the duration of discontinuation analysis. Overall, 68/85 (80%) were type A responders. During the treatment period, 7/85 (8.2%) patients received other antipsoriatic therapies. Improvements in mean DLQI score (-71.5%) and mean BSA involvement (-79.2%) were also observed. Etanercept was well tolerated. During the discontinuation period, 40/77 (51.9%) patients used other antipsoriatic medications (group 1) and 37/77 (48.1%) did not (group 2). The mean duration of discontinuation was significantly longer in group 1 (174 days) than in group 2 (117 days, log-rank test: p = 0.0013). Conclusion: In clinical practice, the duration of discontinuation from etanercept was in accordance with previously reported data, and was longer in patients who received other antipsoriatic drugs during discontinuation of etanercept than in those who did not. High rates of PASI50 and PASI75 response were obtained with etanercept, and these rates were higher than those observed in controlled clinical studies. Etanercept treatment was flexible, effective and well tolerated, and was associated with improved quality of life. \ua9 2010 Adis Data Information BV. All rights reserved