Clinical utility of ingenol mebutate in the management of actinic keratosis. Perspectives from clinical practice

Actinic keratoses (AKs) are epidermal cutaneous neoplasia observed predominantly in middle-aged and older subjects with mainly photo type I and photo type II on sun-exposed surfaces as a result of DNA damage. AKs have historically been characterized as being "precancerous"; however, now it is considered by many authors a carcinoma in situ that can persist or progress to invasive squamous cell carcinoma (SCC) with metastatic potential. Despite the advances in the recognition of typical clinic, dermoscopic and histologic patterns, currently it is not yet possible to predict which AKs will progress to SCC. For this reason, early diagnosis and effective therapy are recommended based on cost/risk/benefit analysis. Current treatment consists of lesion-directed or field-directed therapies or a combination of both. Among the topical field therapies, ingenol mebutate stands out for its therapeutic efficacy, both as directed lesion therapy and as field directed therapy. The aim of this review is to demonstrate the utility of ingenol mebutate in the management of AK in daily clinical practice and to highlight data from real world in order to confirm evidence from pivotal studies. In order to explore clinical data from real world, PubMed searches were performed with the search terms "clinical data ingenol mebutate" and "real world ingenol mebutate". The hits were examined for relevant articles using defaults criteria. The timeframe for the sample search started from the first publication on this topic in 2008 up to now. A total of 23 articles were found using the keywords specified above. The overview points out a low number of real-life studies on the effectiveness and tolerability of this novel treatment due to short period of clinical experience for its recent approval. Further real-life studies are required in order to better identify the efficacy, safety and adherence of the drug on a larger population

Exploiting nutritional value of staple foods in world’s semi-arid areas: risks and benefits, challenges and opportunities of sorghum

Sorghum (Sorghum bicolor (L.) Moench) is a drought-resistant crop and an important food resource in terms of nutritional as well as social-economic values, especially in semi-arid environments. Cultivar selection and processing methods have been observed to impact on composition and functional and nutritional value of sorghum. Amino acid imbalance, cyanogenic glycosides, endogenous anti-nutrients, mycotoxins and toxic elements are among factors impairing its nutritional value. This paper reviews possible approaches (varieties selection, production practices, cooking processes) to improve the benefits-to-risks balance of sorghum meal, to mitigate the risk of deficiencies and/or imbalances and to improve effects on human nutrition. Opportunity for avoiding dietary diversification in high sorghum consumers is also discussed, e.g., tryptophan and niacin deficits potentially related to pellagra, or unavailability of proteins and divalent cations (e.g., Fe, Zn) due to the antinutrient activity of phytic acid and tannins. As potential candidate for production investments, the role of sorghum in preserving biological diversity is also considered.JRC.J.4-Agriculture and Life Sciences in the Econom

Impact of food processing on tannins and phytic acid activities in sorghum porridge: integrated in vitro and analytical approaches

Cinque varietà di sorgo (Sorghum bicolor (L.) Moench) provenienti da Nigeria, Senegal, Burkina Faso e due dall’Italia, sono state caratterizzate per il loro profilo nutrizionale, analizzando la modulazione di due marcatori cellulari (contenuto in proteine totali e attività della GPx), il contenuto di fattori chelanti (tannini e fitati), l’attività fitasica e il contenuto, la bioaccessibilità e la biodisponibilità di ferro e zinco e analizzando l’impatto di due importanti processi alimentari, quali fermentazione e cottura. I risultati mostrano che sia la varietà sia il processo influenzano la maggior parte dei parametri. Tannini e fitati, elementi in traccia, contenuto proteico totale e il processo (soprattutto la fermentazione) sono modulati dalla varietà. La fermentazione riduce il contenuto di fattori chelanti e aumenta l’attività fitasica, incrementando, così, la biodisponibilità degli elementi in traccia; mentre la cottura non ha un impatto significativo. D’altra parte, la fermentazione ha un impatto negativo su entrambi i marcatori cellulari, mentre la cottura solo sul contenuto proteico totale. Le varietà africane, soprattutto quella dal Senegal, hanno mostrato il migliore profilo nutrizionale, mentre, globalmente, le italiane il peggiore. I risultati indicano che la selezione di varietà e di adeguati processi alimentari può avere un impatto significativo sul valore nutrizionale del sorgo.Five sorghum cultivars (Sorghum bicolor (L.) Moench) from Nigeria, Senegal, Burkina Faso and Italy (two), were characterized for their nutritional values by analysing the modulation of cellular functional markers (total protein content and GPx activity), chelating factors (iron-binding phenolic groups and phytates) content and phytase activity, as well as iron and zinc content, bioaccessibility and bioavailability, also considering the impact of food processing methods as fermentation and cooking. The results revealed that both variety and food processing affect most of the tested parameters. Chelating factors, trace elements, cellular total protein content, as well as the effect of processing (mainly fermentation) were modulated by variety. Fermentation decreased chelating factors content, as well as increased phytase activity, leading to enhancement of iron and zinc estimated bioavailability, whereas cooking had no substantial impact. On the other hand, fermentation process had a negative impact on both cellular functional markers while cooking only on the cellular total protein content. The African varieties, particularly the Senegal one, showed the most promising nutritional profile, whereas the two Italian varieties overall showed a poor one. The results indicate that selection of traditional varieties and processing methods can have a significant impact on parameters relevant to sorghum nutritional value

Boosting the Fertilizer Production in Kenya: a CGE analysis

Food security remains a key challenge in many Sub-Saharan African countries and in Kenya in particular. Kenya addresses this concern with a noteworthy policy mix, aiming at giving to the agricultural sector a leading task in improving food security. In this paper, through a Computable General Equilibrium (CGE) model specifically modified for the context of developing country analyses, we address the impacts of the construction of a new fertilizer plant on the agricultural sector and the rest of the economy. For the purpose of the study, a desegregated version of a 2014 Social Accounting Matrix (SAM) has been developed. Results suggests that increasing domestic production of fertilizers do not fully achieve the objectives of reducing rural poverty and increasing agricultural production without complementary policies that help small-holder farmers to overcome the backward technology trap and give them better access to input and output markets.JRC.D.4-Economics of Agricultur

Gender matter in isotretinoin therapy for acne vulgaris? A retrospective study

Introduction: Gender differences have been recently highlighted for several aspects of acne vulgaris such as epidemiology, pathogenesis, clinical course, quality of life and treatment outcome. In particular a shorter but more severe clinical course has been reported in males than in females; nevertheless, usually men have their quality of life less affected. Aim: To determine if the response and the adverse events to 1 cycle of oral isotretinoin therapy can be influenced by gender. Methods: A retrospective study was conducted on consecutive patients affected by acne vulgaris and treated with oral isotretinoin. Global acne grading system (GAGS), acne-related quality of life (AQoL) and isotretinoin-related adverse events were considered as outcome measures and were evaluated before (T0), every month during administration and 4 weeks after the withdrawal (T1) of oral isotretinoin therapy. Mann-Whitney U test and Wilcoxon signed-rank test were used for quantitative parameters and Fisher exact test for qualitative ones. Results: Forty-nine acneic patients were retrospectively selected (33 males 67.3% and 16 females -32.7%; median age: 19 years). Patients had received a median dosage of isotretinoin of 0.4 mg/kg/die for a median period of 5 months; no differences in outcome measures among genders were reported. Limitations: The study is retrospective and the sample is small and not homogenously distributed among genders, as males are double in number than females. Conclusions: In our study population gender didn't influence neither the clinical and the quality of life outcome measures nor the occurrence of adverse events to oral isotretinoin therapy for acne

Factors influencing response to ingenol mebutate therapy for actinic keratosis of face and scalp

AIM To determine factors independently influencing response to ingenol mebutate therapy and assess efficacy on clinical setting of non-hypertrophic non-hyperkeratotic actinic keratosis (AK). METHODS Consecutive patients affected by non-hypertrophic non-hyperkeratotic AKs of the face or scalp were enrolled to receive ingenol mebutate 0.015% gel on a selected skin area of 25 cm2 for 3 consecutive days. Local skin reactions were calculated at each follow up visit using a validated composite score. Efficacy was evaluated by the comparison of clinical and dermoscopic pictures before the treatment and at day 57, and classified as complete, partial and poor response. RESULTS A number of 130 patients were enrolled, of which 101 (77.7%) were treated on the face, while 29 (22.3%) on the scalp. The great majority of our study population (n = 119, 91.5%) reached at least a 75% clearance of AKs and, in particular, 58 patients (44.6%) achieved a complete response while 61 (46.9%) a partial one. Logistic backward multivariate analysis showed that facial localization, level of local skin reaction (LSR) at day 2, the highest LSR values and level of crusts at day 8 were factors independently associated with the achievement of a complete response. CONCLUSION Ingenol mebutate 0.015% gel, when properly applied, is more effective on the face than on the scalp and efficacy is directly associated to LSR score

Efficacy of Cemiplimab in a patient affected by Cutaneous Squamous Cell Carcinoma and Myelodysplastic Syndrome

Cutaneous squamous cell carcinoma (cSCC) is a prevalent skin malignancy, often managed through surgical intervention. However, in certain cases, especially when complicated by concurrent hematologic disorders such as myelodysplastic syndrome (MDS), treatment options become more challenging. This abstract highlights a case study examining the efficacy of cemiplimab, a monoclonal antibody targeting programmed cell death protein 1 (PD-1), in a patient diagnosed with both cSCC and MDS. The patient, initially presenting with an advanced cSCC lesion and underlying MDS, underwent treatment with cemiplimab as a therapeutic approach. Monitoring of the patient's response included clinical evaluation, radiological assessments, and laboratory analyses. Results demonstrated a notable reduction in the size of the cSCC lesion and stabilization of hematologic parameters, suggesting a positive therapeutic effect of cemiplimab in this complex clinical scenario. This case underscores the potential utility of immunotherapeutic agents, specifically PD-1 inhibitors like cemiplimab, in the management of cutaneous malignancies coexisting with hematologic disorders. Further investigations and larger-scale studies are warranted to validate these findings and establish cemiplimab's role as a viable treatment option in similar clinical contexts

Erythrodermic Psoriasis Successfully Treated with Anti IL-17: A Case Series

Erythrodermic psoriasis (EP) is a very rare but extremely severe subtype of chronic plaque psoriasis, affecting 1.00-2.25% of patients with psoriasis (1). Its pathogenesis still remains unknown, and current therapeutic strategies frequently end in failure. In this condition, the skin becomes diffusely red, tending to purple, shiny, with marked desquamation and exudation. Erythema and edema are widespread, covering more than 90% of the body surface and can lead to high risk of multi-organ failure and death (2) due to fluid and protein loss. Predominance of the Th2 immune response and dysregulation of angiogenesis have been proposed to be implicated in the pathogenesis of EP, although this has not yet been fully elucidated (3). Nevertheless, Th17 has been shown to be the second-most predominant T-cell type after Th2 in EP lesions (4,5)

Erythrodermic Psoriasis Successfully Treated with Anti IL-17: A Case Series

Erythrodermic psoriasis (EP) is a very rare but extremely severe subtype of chronic plaque psoriasis, affecting 1.00-2.25% of patients with psoriasis (1). Its pathogenesis still remains unknown, and current therapeutic strategies frequently end in failure. In this condition, the skin becomes diffusely red, tending to purple, shiny, with marked desquamation and exudation. Erythema and edema are widespread, covering more than 90% of the body surface and can lead to high risk of multi-organ failure and death (2) due to fluid and protein loss. Predominance of the Th2 immune response and dysregulation of angiogenesis have been proposed to be implicated in the pathogenesis of EP, although this has not yet been fully elucidated (3). Nevertheless, Th17 has been shown to be the second-most predominant T-cell type after Th2 in EP lesions (4,5)