Non-Invasive Analysis of Actinic Keratosis before and after Topical Treatment Using a Cold Stimulation and Near-Infrared Spectroscopy

Background and objectives: The possible evolution of actinic keratoses (AKs) into invasive squamous cell carcinomas (SCC) makes their treatment and monitoring essential. AKs are typically monitored before and after treatment only through a visual analysis, lacking a quantitative measure to determine treatment effectiveness. Near-infrared spectroscopy (NIRS) is a non-invasive measure of the relative change of oxy-hemoglobin and deoxy-hemoglobin (O2Hb and HHb) in tissues. The aim of our study is to determine if a time and frequency analysis of the NIRS signals acquired from the skin lesion before and after a topical treatment can highlight quantitative differences between the AK skin lesion area. Materials and Methods: The NIRS signals were acquired from the skin lesions of twenty-two patients, with the same acquisition protocol: baseline signals, application of an ice pack near the lesion, removal of ice pack and acquisition of vascular recovery. We calculated 18 features from the NIRS signals, and we applied multivariate analysis of variance (MANOVA) to compare differences between the NIRS signals acquired before and after the therapy. Results: The MANOVA showed that the features computed on the NIRS signals before and after treatment could be considered as two statistically separate groups, after the ice pack removal. Conclusions: Overall, the NIRS technique with the cold stimulation may be useful to support non-invasive and quantitative lesion analysis and regression after a treatment. The results provide a baseline from which to further study skin lesions and the effects of various treatments

Efficacy of new class I medical device for actinic keratoses: a randomized controlled prospective study

AbstractBackground: The presence of Actinic Keratoses (AKs) represent the most important warning sign of subclinical ultraviolet radiation. Currently, the regular use of sunscreens is considered es..

Facial dermatoses and use of protective mask during Covid-19 pandemic: A clinical and psychological evaluation in patients affected by moderate-severe atopic dermatitis under treatment with dupilumab

During the SARS-COV-2 pandemic, using face masks became mandatory in many countries. Although evidence suggests that masks can exacerbate several inflammatory skin diseases, few studies focus on their real impact on eczema localized to the face in atopic dermatitis (AD) patients. The aim of this study is to evaluate facial eczema prevalence during pandemic and its psychological impact in AD patients pre-assessed for systemic treatment and/or in therapy with dupilumab. This study includes 71 patients affected by moderate-severe AD, treated with dupilumab at SCDU of Dermatology in Novara, Italy. We calculated the number of subjects with facial involvement in pre- and post-pandemic periods and the related localization trend. We evaluated, in the two groups, clinical and psychological indicators recorded at each visit and the score modifications during the observational period. No statistically significant differences were observed in facial eczema prevalence, between pre- and post-pandemic periods (p = 0.7618) and in facial eczema remission among the two groups (p = 0.1903). In post-pandemic period, psychological scores were significantly lower (DLQI and HADS respectively with p < 0.0001 and p = 0.0025) and the reduction in EASI score during observational period was significantly greater (p = 0.0001). Our analysis revealed a potential protective effect of masks on face eczema, suggesting that they could enhance dupilumab efficacy. Face masks, covering sensitive areas, can positively contribute to mental distress in patients with facial eczema, and being associated with a lower allergic diseases incidence may sustain dupilumab in reducing AD severity

AKASI and Near-Infrared Spectroscopy in the combined effectiveness evaluation of an actinic keratoses preventive product in immunocompetent and immunocompromised patients

Introduction: The high incidence of actinic keratoses among both the elderly population and immunocompromised subjects and the considerable risk of progression from in situ to invasive neoplasms makes it essential to identify new prevention, treatment, and monitoring strategies.Objective: The aim of this study was to evaluate the efficacy on AKs of a topical product ((R) Rilastil AK Repair 100 +) containing high-protection sunscreens, a DNA Repair Complex with antioxidant and repairing action against UV-induced DNA damage, and nicotinamide, a water-soluble derivative of vitamin B3 that demonstrated several photoprotective effects both in vitro and in vivo.Methods: The study enrolled 74 Caucasian patients, which included 42 immunocompetent and 32 immunosuppressed subjects. The efficacy of the treatment has been evaluated through the clinical index AKASI score and the non-invasive Near-Infrared Spectroscopy method.Results: The AKASI score proved to be a valid tool to verify the efficacy of the product under study, highlighting an average percentage reduction at the end of treatment of 31.37% in immunocompetent patients and 22.76% in organ transplant recipients, in comparison to the initial values, with a statistically significant reduction also in the single time intervals (T0 vs. T1 and T1 vs. T2) in both groups. On the contrary, the Near-Infrared Spectroscopy (a non-invasive technique that evaluates hemoglobin relative concentration variations) did not find significant differences for O(2)Hb and HHb signals before and after the treatment, probably because the active ingredients of the product under study can repair the photo-induced cell damage, but do not significantly modify the vascularization of the treated areas.Conclusion: The results deriving from this study demonstrate the efficacy of the product under study, confirming the usefulness of the AKASI score in monitoring treated patients. Near-Infrared Spectroscopy could represent an interesting strategy for AK patients monitoring, even if further large-scale studies will be needed

AVALIAÇÃO CLÍNICA DA FENILBUTAZONA EM BOVINOS

Apresentam-se resultados de um ensaio clínico utilizando- se a fenilbutazona em bovinos, em estudo realizado tendo como casuística clínica animais atendidos em propriedades rurais localizadas no município de Londrina, estado do Paraná. A partir de processos inflamatórios diversos e de prescrições pós-cirúrgicas emergenciais e programadas, a droga foi avaliada considerando-se, como quesito à discussão, o período de convalescença dos animais, os sinais clíinicos da recuperação deles e os possíves efeitos tóxicos. Com isso, foi possível avaliar o medicamento e a respectiva contribuição à terapêutica veterinária, já que o produto, em questão, é uma preparação exclusiva para uso em animais domésticos, incluindo os bovinos. PALAVRAS-CHAVE: Bovinos, estudo clínico, fenilbutazona

Teores de fósforo e flúor em suplementos minerais para bovinos comercializados no estado do Paraná

A deficiência de fósforo em bovinos é um fator significativo, que contribui para a baixa produtividade do rebanho nacional. Por essa razão, na atividade pecuária é imprescindível a mineralização dos animais com este macroelemento. Foram quantificados os teores de Fósforo (P) e Flúor (F) em trinta diferentes amostras de suplementos minerais já misturados de fábrica, sendo marcas de expressiva comercialização no Estado do Paraná. As amostras colhidas referem-se a produtos misturados e destinados exclusivamente para consumo de bovinos, com indicação do fabricante de 90g de Fósforo por quilo de produto. Para a determinação do Fósforo foi utilizado espectrofotômetro de colorimetria com região UV visível e para a determinação do Flúor utilizou-se eletrodo de íon específico para o elemento e potenciômetro com escala em milivolts. Os resultados mostraram diferentes proporções e alterações na relação P:F, com variadas concentrações dos elementos, principalmente do Fósforo, possibilitando a conclusão de que quase todas as formulações caracterizaram-se como incorretas pelas informações prestadas nos rótulos dos fabricantes e irregulares na relação P:F calculada, quando comparada aos limites estabelecidos pela normatização em vigor no país

Teledermoscopy in the Diagnosis of Melanocytic and Non-Melanocytic Skin Lesions: NurugoTM Derma Smartphone Microscope as a Possible New Tool in Daily Clinical Practice

Background: Due to the COVID-19 pandemic, teledermoscopy has been increasingly used in the remote diagnosis of skin cancers. In a study conducted in 2020, we demonstrated a potential role of an inexpensive device (NurugoTM Derma) as a first triage to select the skin lesions that require a face-to-face consultation with dermatologists. Herein, we report the results of a novel study that aimed to better investigate the performance of NurugoTM. Objectives: (i) verify whether the NurugoTM can be a communication tool between the general practitioner (GP) and dermatologist in the first assessment of skin lesions, (ii) analyze the degree of diagnostic–therapeutic agreement between dermatologists, (iii) estimate the number of potentially serious diagnostic errors. Methods: One hundred and forty-four images of skin lesions were collected at the Dermatology Outpatient Clinic in Novara using a conventional dermatoscope (instrument F), the NurugoTM (instrument N), and the latter with the interposition of a laboratory slide (instrument V). The images were evaluated in-blind by four dermatologists, and each was asked to make a diagnosis and to specify a possible treatment. Results: Our data show that F gave higher agreement values for all dermatologists, concerning the real clinical diagnosis. Nevertheless, a medium/moderate agreement value was obtained also for N and V instruments and that can be considered encouraging and indicate that all examined tools can potentially be used for the first screening of skin lesions. The total amount of misclassified lesions was limited (especially with the V tool), with up to nine malignant lesions wrongly classified as benign. Conclusions: NurugoTM, with adequate training, can be used to build a specific support network between GP and dermatologist or between dermatologists. Furthermore, its use could be extended to the diagnosis and follow-up of other skin diseases, especially for frail patients in emergencies, such as the current pandemic context

Urinary soluble VCAM-1 is a useful biomarker of disease activity and treatment response in lupus nephritis

Introduction: Vascular cell adhesion molecule-1 (VCAM-1) is involved in the progression of glomerular and tubulointerstitial injury in lupus nephritis (LN) and can be easily assessed in urine. The aim of this study was to assess urinary soluble VCAM-1 (uVCAM-1) as a biomarker of disease activity and treatment response in LN. Methods: This prospective study enrolled 62 patients with class III, IV or V LN diagnosed within the last 3 years and divided them in two groups: with and without active nephritis at the inclusion, each group with 31 patients. At each visit, a urine sample was collected for uVCAM-1 evaluation and the nephritis status was assessed. Results: Median uVCAM-1 level was elevated in patients with active compared to inactive LN (P < 0.001). The ROC curve of uVCAM-1 demonstrated an AUC of 0.84 and a cutoff of 47.2 ng/mgCr yielded a good sensitivity (74.2%) and specificity (74.2%) for the diagnosis of active LN. A significant correlation was found between uVCAM-1 level and renal activity scores and traditional biomarkers of LN. The level of uVCAM-1 dropped in patients with active LN who went into remission (P < 0.001), increased in patients who went into activity (P = 0.002) and did not change in patients who remained inactive (P = 0.797). The level of uVCAM-1 peaked during the flare of LN (P < 0.05). Conclusion: The uVCAM-1 is a reliable biomarker that reflects renal disease activity and is useful for monitoring individual patients with lupus nephritis over time

O destino dos rins transplantados tratados com OKT3 para rejeição córtico-resistente

OBJECTIVE: To evaluate the long-term effects of the monoclonal antibody anti-CD3 (OKT3), used to treat steroid-resistant acute renal allograft rejection, on allograft function and long-term allograft and patient survival. MATERIALS AND METHODS: We studied 231 kidney transplants from living and cadaver donors and with prednisone, azathioprine and cyclosporin used for baseline immunosuppression. Diagnosis of acute rejection was based on clinical and laboratory criteria. Sixty-three (27.2%) patients did not present acute rejection, 135 (58.4%) presented steroid-sensitive rejection, and 33 (14.2%) received OKT3 as a rescue therapy for steroid-resistant rejection. We evaluated demographic data, serum creatinine, and allograft and patient survival up to the 5th posttransplant year, as well as causes of graft loss and patient death. RESULTS: Vascular anastomosis time and prevalence of  acute tubular necrosis were significantly higher in OKT3- reated patients. Average serum creatinine was not different between steroid-sensitive and steroid-resistant patients. Graft survival in the first year was poorer in the OKT3 group as compared to the non-rejection (P = 0.001) and steroidsensitive rejection (P = 0.04) groups; there was no difference, however, in the survival up to the 5th posttransplant year. In transplants from cadaver donors, graft survival was statistically different only between OKT3 and non-rejection patients. Patient survival did not differ between the 3 groups up to the end of the follow-up. There were no differences in causes of graft loss, but the proportion of deaths associated with infection was greater in patients treated with OKT3. CONCLUSIONS: OKT3 used for rescue therapy in steroid--resistant acute rejection was not associated with poorer renal graft function or survival over the 5-year follow-up period. However, graft survival in the first year was significantly poorer in patients that needed OKT3. The use of a more potent immunosuppression did not result in higher mortality rates up to the 5th year of posttransplant, but OKT3-treated recipients presented a higher incidence of deaths related to infection. OBJETIVO: Avaliar o efeito do anticorpo monoclonal anti-CD3 (OKT3), utilizado para tratamento de rejeição aguda córtico-resistente em pacientes transplantados renais, em relação à função do rim transplantado e à sobrevida do enxerto e do paciente a longo prazo.PACIENTES E MÉTODOS: Foram estudados 231 pacientes transplantados renais de doador vivo e cadavérico, tendo como imunossupressão de base prednisona, azatioprina e ciclosporina. O diagnóstico de rejeição aguda baseou-se em critérios clínicos e laboratoriais. Sessenta e três (27,2%) pacientes não apresentaram rejeição aguda, 135 (58,4%) tiveram rejeição córtico-sensível e 33 (14,2%) receberam OKT3 para rejeição córtico-resistente. Foram avaliados dados demográficos, função do enxerto, sobrevida do enxerto e do paciente até o quinto ano de transplante, bem como as causas de perda do rim transplantado e de óbito.RESULTADOS: O tempo de anastomose vascular e a prevalência de necrose tubular aguda foram significativamente maiores nos pacientes que receberam OKT3. A média da creatinina sérica do grupo OKT3 não diferiu do grupo com rejeição córtico-sensível. A sobrevida do enxerto no primeiro ano foi significativamente pior no grupo tratado com OKT3 em relação ao pacientes sem rejeição (P = 0,001) e com rejeição córticoresponsiva (P = 0,04), mas a sobrevida ao final do seguimento não diferiu. Nos transplantes cadavéricos, a diferença ocorreu apenas entre o grupo OKT3 e os pacientes sem rejeição. A sobrevida do paciente em 5 anos foi semelhante entre os 3 grupos. Não houve diferença nas causas de perda do enxerto, mas a proporção de óbitos associados à infecção foi maior nos pacientes que utilizaram OKT3.CONCLUSÕES: O uso de OKT3 como terapia de resgate não esteve associado a uma pior função ou pior sobrevida do enxerto renal em 5 anos, mas no primeiro ano a sobrevida do enxerto foi significativamente menor nos pacientes tratados com OKT3. O emprego de uma imunossupressão mais potente não se refletiu em maior mortalidade até o 5º ano do transplante, mas o grupo que utilizou OKT3 apresentou uma maior incidência de óbitos associados à infecção