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

Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

L'architettura della Chiesa di San Fermo Maggiore a Verona: secolo 11.

Dottorato di ricerca in storia dell' arte. 12. Ciclo. A.a. 1996-99Consiglio Nazionale delle Ricerche - Biblioteca Centrale - P.le Aldo Moro, 7, Rome; Biblioteca Nazionale Centrale - P.za Cavalleggeri, 1, Florence / CNR - Consiglio Nazionale delle RichercheSIGLEITItal

Severe injection site reaction ensuing the first dose of mRNA COVID-19 vaccine

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Keratolysis exfoliativa-like eruption induced by ranolazine

Dermatoses affecting palms may represent a dermatologic challenge from both the diagnostic, and therapeutic point of view. Patients with supposedly occupational dermatitis can spend months or even years in a frustrating attempt to avoid contact with possible irritants or allergens. To underline the importance of a thorough unbiased analysis of the patient's history and clinical features, we present the iconic case of a bricklayer affected by a chronic, disabling desquamation of palms which in the end was classified as keratolysis exfoliativa (KE) attributed to ranolazine-intake, an antianginal drug. To the best of our knowledge, this specific adverse effect of drug-induced KE of palms has never been reported before in association with ranolazine

Assessment of exposure to oak wood dust using gallic acid as a chemical marker.

Objectives: The American Conference of Governmental Industrial Hygienists (ACGIH) has classified oak dusts as human carcinogens (A1), based on increased sinus and nasal cancer rates among exposed workers. The aims of this study were to investigate the use of gallic acid (GA) as chemical marker of occupational exposure to oak dusts, to develop a high-performance liquid chromatography\u2013diode array detector (HPLC\u2013DAD) method to quantify it, and to apply the method in the analysis of oak dust samples collected in some factories.Methods: A high performance liquid chromatography (HPLC) method was developed to detect GA in oak wood dust. The method was tested on field, and GA was extracted from oak wood dust sampled in the air of five wood-working plants where only oak wood is used. Results: A total of 57 samplings was taken in the dust concentration range 0.271-11.138 mg/m3. Five of these exceeded the Italian threshold limit value of 5 mg/m3, and 30 exceeded the ACGIH TLV of 1 mg/m3. GA concentrations were in the range 0.017-4.178 \ub5g/m3. The total oak dust sampled was correlated with GA contents with a coefficient of 0.95. Conclusions: The GA in tannic extracts of oak wood turned out to be specific for this type of wood, showing that its concentration in wood dust sampled in the work environment is useful in assessing true exposure to carcinogenic oak dust

Indicatori di dose e di effetto nell\u2019esposizione a sevoflurano

Abstract The aim of this study was to determine the relationship between exposure biomarkers and renal and liver effect indicators in subjects exposed to sevoflurane. Many of the subjects show exposure to sevoflurane below the environmental threshold limit of 2 ppm established by NIOSH for halogenate compounds (mean: 0.161 ppm; median: 0.027 ppm; range: 0.007-2.71 ppm); urinary excretion of sevoflurane appeared to be influenced by exposure peaks, so that the metabolite hexafluoroisopropanol (HFIP) seemed to be more reliable as an exposure indicator. Statistically significant correlations were found between HFIP and renal biomarkers (N-acetyl-\u3b2-D-glucosaminidase and glutamine-synthetase); no differences between controls and exposed subjects in D-glucaric acid excretion were found for sevoflurane alone, but there was a significant difference with respect to the control group in combined exposure to N2O and sevoflurane