Combined heart and liver transplantation: an updated systematic review.

INTRODUCTION: Combined heart and liver transplantation (CHLT) is one of the most complex procedures of surgery that has been implemented in the last 35 years. The aim of our meta-analysis was to investigate the safety and efficacy of CHLT. MATERIALS: The meta-analysis was designed according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) and AMSTAR (A MeaSurement Tool to Assess systematic Reviews) recommendations. A literature search was conducted up to April 2020 using the MEDLINE,® SCOPUS,® ClinicalTrials.gov, Embase™, Cochrane Central Register of Controlled Trials and Google Scholar™ databases. RESULTS: Our meta-analysis included 16 studies with 860 patients. The mortality rate following CHLT was 14.1%. One and five-year survival rates were 85.3% and 71.4% while the heart and liver rejection rates were 6.1% and 9.1% respectively. The hospital stay was 25.8 days and the intensive care unit stay was 9.9 days. Pooled values were also calculated for cardiopulmonary bypass duration, units of transfused red blood cells and fresh frozen plasma, postoperative infection rate, mechanical ventilation rate and follow-up duration. CONCLUSIONS: Despite its complexity, CHLT is a safe and effective procedure for the management of lethal diseases that lead to progressive heart and/or liver failure. Nevertheless, there must be strict adherence to the indications for surgery, and future studies should compare CHLT with isolated cardiac and hepatic transplantations.

Combined heart and liver transplantation: an updated systematic review.

INTRODUCTION: Combined heart and liver transplantation (CHLT) is one of the most complex procedures of surgery that has been implemented in the last 35 years. The aim of our meta-analysis was to investigate the safety and efficacy of CHLT. MATERIALS: The meta-analysis was designed according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) and AMSTAR (A MeaSurement Tool to Assess systematic Reviews) recommendations. A literature search was conducted up to April 2020 using the MEDLINE,® SCOPUS,® ClinicalTrials.gov, Embase™, Cochrane Central Register of Controlled Trials and Google Scholar™ databases. RESULTS: Our meta-analysis included 16 studies with 860 patients. The mortality rate following CHLT was 14.1%. One and five-year survival rates were 85.3% and 71.4% while the heart and liver rejection rates were 6.1% and 9.1% respectively. The hospital stay was 25.8 days and the intensive care unit stay was 9.9 days. Pooled values were also calculated for cardiopulmonary bypass duration, units of transfused red blood cells and fresh frozen plasma, postoperative infection rate, mechanical ventilation rate and follow-up duration. CONCLUSIONS: Despite its complexity, CHLT is a safe and effective procedure for the management of lethal diseases that lead to progressive heart and/or liver failure. Nevertheless, there must be strict adherence to the indications for surgery, and future studies should compare CHLT with isolated cardiac and hepatic transplantations.

Avoiding appendectomy with an ultrasound probe.

Acute appendicitis is common in patients with right lower quadrant pain and affects all gender and age groups. Because clinical diagnosis of patients with right lower quadrant pain remains a challenge to emergency physicians and surgeons, imaging is of major importance. Ultrasound has well-established direct and indirect signs for diagnosing acute appendicitis and revealing the presence of an appendicolith. Appendectomy, which can be either open or laparoscopic, constitutes the basic treatment. However, the need for an appendectomy is debatable, particularly in high-risk patients. We report the case of a 42-year-old woman with no relevant medical history who was sent to the emergency department by her family physician with right lower quadrant pain of 18 hours' duration. Using ultrasound, the emergency physicians identified, inside the appendix, a 0.6cm appendiceal faecolith, migration of which was eventuated by manipulation of the ultrasound probe. The patient was then successfully treated non-operatively without any antibiotic prescription. Despite its rarity, migration of an appendiceal faecolith is possible. When migration of an appendicolith is perhaps actualised spontaneously or by ultrasound probe manipulation, the likelihood of an appendectomy decreases dramatically. This hypothesis provides patients who present an appendiceal faecolith with an alternative treatment approach that will lead to the avoidance of surgery, minimise morbidity and reduce hospitalisation costs.

Could FiLaC™ be effective in the treatment of anal fistulas? A systematic review of observational studies and proportional meta-analysis.

AIM: Fistula Laser Closure (FiLaC™) is a novel sphincter-preserving technique that is based on new technologies and shows promising results in repairing anal fistulas whilst maintaining external sphincter function. The aim of the present meta-analysis is to present the efficacy and the safety of FiLaC™ in the management of anal fistula disease. METHOD: The present proportional meta-analysis was designed using the PRISMA and AMSTAR guidelines. We searched MEDLINE, Scopus, clinicaltrials.gov, Embase, Cochrane Central Register of Controlled Trials CENTRAL and Google Scholar databases from inception until November 2019. RESULTS: Overall, eight studies were included that recruited 476 patients. The pooled success rate of the technique was 63% (95% CI 50%-75%). The pooled complication rate was 8% (95% CI 1%-18%). Sixty-six per cent of patients had a transsphincteric fistula and 60% had undergone a previous surgical intervention, mainly the insertion of a seton (54%). The majority had a cryptoglandular fistula. Operation time and follow-up period were described for each study. CONCLUSION: FiLaC™ seems to be an efficient therapeutic option for perianal fistula disease with an adequate level of safety that preserves quality of life. Nevertheless, randomized trials need to be designed to compare FiLaC™ with other procedures for the management of anal fistulas such as ligation of intersphincteric fistula tract, anal advancement flaps, fibrin glue, collagen paste, autologous adipose tissue, fistula plug and video-assisted anal fistula treatment.

Is the laparoscopic approach a safe choice for the management of acute appendicitis in pregnant women? A meta-analysis of observational studies.

INTRODUCTION: Acute appendicitis is a common and serious situation during pregnancy, because of the increased risk of fetal loss and perforation in the third trimester, as well as a diagnostic difficulty. During recent years laparoscopic approach has been introduced to clinical practice with encouraging results. The purpose of this meta-analysis is to compare the surgical and obstetrical outcomes between laparoscopic and open appendectomy during pregnancy. MATERIALS AND METHODS: MEDLINE, SCOPUS, Clinicaltrials.gov, CENTRAL and Google Scholar were searched for studies reporting on postoperative outcomes between laparoscopic and open appendectomy during pregnancy. The random effects model (DerSimonian-Laird) was used to calculate pooled effect estimates when high heterogeneity was encountered, otherwise the fixed-effects (Mantel-Haenszel) model was implemented. RESULTS: Twenty-one studies that enrolled 6276 pregnant women are included in the present meta-analysis. Of these women, 1963 underwent laparoscopic appendectomy and 4313 underwent an open appendectomy. Women who underwent laparoscopic appendectomy demonstrated an increase in fetal loss risk, while neonates of women that underwent open appendectomy presented decreased Apgar score at five minutes after birth. All the rest outcomes were similar between the two groups. The time that each study took place seemed to affect the comparison of birth weight and postoperative hospital stay between the two groups. CONCLUSION: Laparoscopic appendectomy seems to be a relatively safe therapeutic option in pregnancy when it is indicated. Thus, it should be implemented in clinical practice, always considering the experience of the surgeon in such procedures. Nevertheless, the need of new studies to enhance this statement remains crucial.

Isolation of Aggregatibacter aphrophilus from bronchoalveolar lavage in a paediatric patient presenting with haemoptysis.

We report a rare case of non-cystic fibrosis bronchiectasis accompanied by protracted infection with Aggregatibacter aphrophilus in a 12-year-old boy with haemoptysis.

Expression of autophagy-related proteins Beclin-1 and LC3A and proliferation marker Ki-67 in calculous and acalculous human gallbladder epithelium.

BACKGROUND: Autophagy is an inducible intracellular process that has been studied mostly in cancer and less in inflammatory diseases. To establish the relation between cholecystitis (calculous and acalculous) and autophagy, we studied the expressions of immunohistochemical markers Beclin-1, LC3A, and Ki-67 in gallbladder epithelium and their significance in the induction of autophagy. METHODS: Adult human gallbladder tissues were obtained from 100 patients (45 male, 55 female) who underwent cholecystectomy. According to the findings, the patients were divided into two groups: group A (calculous gallbladder: 24 male, 46 female; mean age 52.6 ± 16.0 years) and group B (acalculous gallbladder: 21 male, nine female; mean age 65.3 ± 12.4 years). The expressions of immunohistochemical markers Beclin-1, LC3A, and Ki-67 in gallbladder epithelium were studied using immunohistochemistry techniques. RESULTS: Beclin-1 expression was correlated with LC3A expression in group A with increased Beclin-1 expression promoting LC3A expression (p =0.0001). In group B, the LC3A expression did not follow Beclin-1 expression (p =0.09). The mean percentage of Beclin-1 expression in group A patients was 23.8 % compared to group B patients, where the corresponding percentage was only 17.3 %. Corresponding mean percent expressions of LC3A in groups A and B were 38.9 % and 50.7 %, respectively. The expression of Ki-67 was higher in group A patients compared to group B patients. The mean percentage of Ki-67 expression in group A patients was 3.75 %, whereas, in group B patients, it was only 0.5 % (statistically significantly different; p =0.0003). CONCLUSION: In the epithelium of calculous cholecystitis, overexpression of LC3A is related to Beclin-1 overexpression, which reinforces the view that Beclin-1 promotes autophagy in stone cholecystitis. HIPPOKRATIA 2019, 23(2): 64-69.

Extensively drug-resistant Acinetobacter baumannii bacteraemia in a multidisciplinary intensive care unit during a 6-year period: Risk factors for fulminant sepsis.

OBJECTIVES: This study aimed to determine potential host-, pathogen-, infection- and treatment-related risk factors that might predict a fulminant fatal course of bacteraemia caused by extensively drug-resistant Acinetobacter baumannii (XDR-Aba). METHODS: Eighty-seven patients with monomicrobial growth of XDR-Aba in blood cultures within a 6-year period (2011-2016) were studied. Patients were divided into three groups according to ICU outcome: Group A (n=40) consisted of patients who survived; Group B (n=10) included patients with fulminant sepsis who died early (≤48h); and Group C (n=37) included patients who died later (>48h) after the onset of bacteraemia. RESULTS: Regarding patient co-morbidities, patients who died from fulminant XDR-Aba bacteraemia had a significantly higher prevalence of chronic renal failure compared with patients who survived (40.0% vs. 7.5%; P=0.029). Patients with fulminant sepsis showed more severe organ dysfunction based on SOFA score compared with survivors (10.83±2.93 vs. 6.65±3.6; P=0.013). The primary to secondary bacteraemia ratio and appropriate treatment were similar among the three outcome groups. Patients with fulminant bacteraemia displayed higher rates of colistin-, tigecycline- and pandrug-resistant strains, although not statistically significant. CONCLUSIONS: Patients suffering from a fulminant course of XDR-Aba bacteraemia showed significantly higher rates of chronic renal failure and multiple organ dysfunction. Resistance patterns of XDR-Aba isolates and receipt of appropriate treatment did not affect outcomes. Further studies including larger samples of patients along with investigation of specific virulence determinants of individual Aba strains are needed.

Mobile applications for obesity and weight management: current market characteristics.

Mobile-Health (mHealth) is the fastest-developing eHealth sector, with over 100 000 health applications (apps) currently available. Overweight/obesity is a problem of wide public concern that is potentially treatable/preventable through mHealth. This study describes the current weight-management app-market. Five app stores (Apple, Google, Amazon, Windows and Blackberry) in UK, US, Russia, Japan and Germany, Italy, France, China, Australia and Canada were searched for keywords: 'weight', 'calorie', 'weight-loss', 'slimming', 'diet', 'dietitian' and 'overweight' in January/February 2016 using App-Annie software. The 10 most downloaded apps in the lifetime of an app were recorded. Developers' lists and the app descriptions were searched to identify any professional input with keywords 'professional', 'dietitian' and 'nutritionist'. A total of 28 905 relevant apps were identified as follows: Apple iTunes=8559 (4634, 54% paid), Google Play=1762 (597, 33.9% paid), Amazon App=13569 (4821, 35.5% paid), Windows=2419 (819, 17% paid) and Blackberry=2596 (940, 36% paid). The 28 905 identified apps focused mainly on physical activity (34%), diet (31%), and recording/monitoring of exercise, calorie intake and body weight (23%). Only 17 apps (0.05%) were developed with identifiable professional input. Apps on weight management are widely available and very popular but currently lack professional content expertise. Encouraging app development based on evidence-based online approaches would assure content quality, allowing healthcare professionals to recommend their use.

[Αnti-Inflammatory medication as adjunctive antidepressive treatment].

Mounting data of evidence that have emerged during the last twenty years, point towards the existence of an inflammatory mechanism underlying the pathophysiology of depressive disorder. These data have inspired a number of clinical studies characterized by the administration of inflammatory response altering medication in addition to conventional medication in depressive disorder patients. The drugs were either Non Steroid Anti-inflammatory Drugs (NSAIDs) or Tumor Necrosis Factor-alpha (TNFa) inhibitors and were selected among those that are already in use for various diseases related to the immune system. The choice of these specific immunomodulatory agents for the co-administration with conventional antidepressive medication was based on a number of laboratory data and clinical evidence. A total of seven relevant clinical trials have been conducted, all of them with promising results that have been published between 2006 and 2013. However, only four out of them were eligibly designed regarding the homogeneity of the study groups, randomization, double-blinding and placebo controlling. These three studies showed clinical advantages of the adjunctive medication as estimated by significant drops in Hamilton scores. Of interest are the findings of the most recent and largest clinical trial of the TNF-a antagonist infliximab which show that treatment with anti-inflammatory agents may be beneficial only in depressive patients with raised levels of baseline inflammatory markers. A limitation of the studies was that, since no guidelines currently exist for anti-inflammatory agents and depression, adjunctive medication could have been under or overdosed. Other limitations were the follow-up period that was rather small and the number of the participants that was also small. Recently, a lot of progress has been made in identifying therapeutic targets along metabolic pathways in the brain relevant to depression, which could be manipulated by immune mediators. In fact, tryptophan -the precursor of serotonin- metabolism appears as an important field of cross reactions between immune and neurochemical mediators and, elucidating it might contribute in new therapeutic strategies. Future clinical trials, eligibly designed, should include the use of biomarkers that reflect inflammatory status or/and metabolic activity in order to identify patients who may be uniquely responsive to immune-targeted therapies. These biomarkers could also serve to objectively monitor therapeutic responses and to determine the appropriate, for each patient, dosage of the new medicine. It is possible that relevant findings can benefit the great population of depression disorder patients that fail to achieve remission and also contribute in the personalization of the treatment of depression.

Effects of calorie labelling on macro- and micro-nutrients in main-meal choices made by young adults.

BACKGROUND/OBJECTIVES: There is limited evidence that prominent calorie labelling on out-of-home meals helps consumers reduce calorie intakes and avoid weight gain, but no evidence on its effects on macro- and micro-nutrients. The objective of this study was to assess the impact of prominent calorie labelling on energy, macro- and micro-nutrients. SUBJECTS/METHODS: Young adults in a catered residential setting were observed when choosing main meals over three study periods in fixed order in this observational study. Period 1: with calorie labels (20 weeks); period 2: without calorie labels (10 weeks); period 3: with calorie labels plus information on estimated energy requirements (10 weeks). Nutrient contents of meal choices were analysed from food composition tables. RESULTS: Energy, 4 macronutrients and 19 micronutrients levels were derived from 4200 meals chosen by 120 subjects over 40 weeks. Means (s.d. or Median) for key macro- and micro-nutrients were for period 1: energy=658 (94) kcal, fat=31 (8.6) g, saturated fat=10.5 (2.7) g, B12=2.5 (1.7) µg, folate=119 (46.8) µg, vitamin C=80.0 (42) mg, Ca=278 (129) mg, Na=1230 (119) mg, Fe=22 (10) g, Se=19 (10.1) µg, I=34 (10.1) µg, period 2: energy=723 (87) kcal, fat=35 (7.6) g, saturated fat=12 (2.7) g, B12=3.4 (1.7) µg, Folate=182 (13.3) µg, vitamin C=87.0 (49.7) mg, Ca=379 (149) mg, Na=1352 (114) mg, Fe=41.6 (14) g, Se=26 (10.3) µg, I=38.0 (18.4) µg, period 3: energy=578 (109) kcal, fat=27.3 (9.1) g, saturated fat=8.5 (2.7) g, B12=2.2 (0.5) µg, Folate=90 (50.8) µg, vitamin C=75.0 (34) mg, Ca=277 (119) mg, Na=1205 (99) mg, Fe=14.5 (10.9) g, Se=15.0 (10) µg, I=32.0 (18.4) µg. All macro- and micro-nutrients, except for B1, vitamin C, vitamin E and Ca were significantly different between the three periods (P<0.001), but all mean intakes remained above recommended levels. CONCLUSIONS: Calorie labelling resulted in reductions in calories, fat and saturated fat contents of the meals chosen, without compromising micronutrient consumptions.

Weight changes in young adults: a mixed-methods study.

OBJECTIVE: In both the United States and United Kingdom, countries with high prevalence of obesity, weight gain is particularly rapid in young adulthood and especially identified among first-year students. DESIGN: A triangulation protocol was used, incorporating quantitative and qualitative research methods. A 27-question online survey was sent to all first-year undergraduates twice, with a 9-month interval. An online focus group was conducted at the end of the year, analysed by content and thematically. Self-reported weights and heights were validated against objectively measured data. RESULTS: From a total of 3010 first-year students, 1440 (female=734) responded at baseline mean (s.d.) age 20 (3.6) years, body mass index 22.3 (4.6) kg m(-2), 17% smokers and 80% alcohol drinkers. At follow-up, 1275 students reported a mean weight change of 1.8 (s.d. 2.6) kg over the 9-month period. Self-reported data correlated strongly with measured weights (r=0.999, P<0.001) and heights (r=0.998, P<0.001). Predictors of weight gain were baseline weight (P<0.001). Dairy products consumption was associated with less weight gain (P<0.001). Fruit and vegetable consumption, and time spent on physical activity or sleeping were associated with neither weight gain nor weight loss. Focus group content analysis revealed weight gain as a major concern, reported by half the participants, and increased alcohol consumption was considered the most common lifestyle change behind weight gain. Thematic analysis identified three main themes as barriers to or facilitators of healthy lifestyles and weight; budget, peer influence and time management. CONCLUSIONS: Rapid weight gain is of concern to young adults. Students living away from home are at particular risk, owing to specific obesogenic behaviours. Consumption of fruit and vegetables, and physical activity, despite popular beliefs, were not associated with protection against weight gain.

Calorie-labelling: does it impact on calorie purchase in catering outlets and the views of young adults?

Calorie-labelling of meals has been suggested as an antiobesity measure, but evidence for impact is scarce. It might have a particular value for young adults, when weight gain is most rapid. A systematic literature review and a meta-analysis was performed to assess the effect of calorie-labelling on calories purchased. Seven studies met the inclusion and quality criteria of which six provided data allowing a meta-analysis. Three reported significant changes, all reductions in calories purchased (-38.1 to -12.4 kcal). Meta-analysis showed no overall effect, -5.8 kcal (95% confidence interval (CI)=-19.4 to 7.8 kcal) but a reduction of -124.5 kcal (95% CI=-150.7 to 113.8 kcal) among those who noticed the calorie-labelling (30-60% of customers). A questionnaire, to gauge views on calorie-labelling, was devised and sent to young adults in higher education: 1440 young adults (mean age 20.3 (s.d.=2.9) years) completed the survey. Nearly half (46%) said they would welcome calorie information in catering settings and on alcoholic drinks. Females opposing to calorie-labelling were heavier to those who did not (64.3 kg vs. 61.9 kg, P=0.03; BMI=22.4 kg m(-2) vs. 21.7 kg m(-2), P=0.02). In conclusion, the limited evidence supports a valuable effect from clearly visible calorie-labelling for obesity prevention, and it appears an attractive strategy to many young adults.

Community acquired quinolone-resistant Escherichia coli pyelonephritis complicated with multiple renal abscesses: a case report.

Acute pyelonephritis is a potentially organ-damaging and life-threatening infection. A 37-year old woman was admitted to Intensive Care Unit in septic shock and multi-organ failure due to acute pyelonephritis with systemic bacterial dissemination caused by a quinolone-resistant Escherichia coli. The patient, a previously healthy woman, reported recurrent episodes of urinary tract infection in the previous 3 years, which were treated with quinolones. Treatment course with broad-spectrum antimicrobial agents reversed her septic shock and multi-organ failure. However, pyelonephritis progressed to intrarenal and perirenal abscesses formation. The patient fully recovered after surgical removal of the infected kidney.

[A volumetric study of brain structures in subtypes of depression].

The aim of this study is to compare the volumes of hippocampus, amygdala and subgenual prefrontal cortex among patients with melancholic depression, patients with psychotic depression and normal controls. Thirty nine patients with a diagnosis of major depression (22 with melancholic and 17 with psychotic subtype) and 18 normal controls were included in the study. Hippocampal, amygdala, anterior and posterior subgenual cortex volumes were measured by manual tracings on magnetic resonance volumetric images and compared across the 3 groups. We identified larger amygdala volumes and smaller left anterior subgenual cortex volumes in both patient groups compared to controls. There were no differences in hippocampal, right anterior and posterior subgenual cortex volumes across the 3 groups. In conclusion, melancholic and psychotic depression were not differentiated regarding the volumes of the hippocampus, the amygdala, and anterior and posterior subgenual cortex, even though amygdala volumes and left anterior subgenual cortex volume of both patient groups were differentiated compared to controls.

The double-arch modified type-1b external skeletal fixator. Technique description and functional outcome for surgical management of canine antebrachial limb deformities.

OBJECTIVES: To describe acute correction of antebrachial angular and rotational limb deformities (ARLD) using a new external skeletal fixator (ESF). METHODS: Dogs that were presented with lameness caused by ARLD were treated by radial and ulnar osteotomies and acute realignment. A modified type-1b ESF incorporating double arches (DA-ESF) and a novel connecting configuration facilitated alignment with six degrees of freedom. Bilateral deformities were corrected surgically in the same session. Aseptic preparation of both antebrachii allowed comparison of limb alignment. Radiographic evaluation was performed using centre of rotation of angulation (CORA) methodology. RESULTS: Thirty-five antebrachii (22 dogs) underwent surgery. Postoperative limb function was graded as good (n = 31), fair (n = 2), or poor (n = 2). Persistent medial carpal instability was associated with a suboptimal outcome. Postoperative radiographic images of the frontal and sagittal plane joint angles and elbow-to-carpus translation were compared with values that were reported in previous studies, and were within published reference ranges in most cases. Complications included delayed radial osteotomy union (n = 5), delayed ulnar osteotomy union (n = 2) and implant-associated morbidity (n = 3). CLINICAL RELEVANCE: A practical technique for acute correction of complex antebrachial ARLD is suggested, incorporating a new configuration of ESF. Putative limitations of radiographic planning using CORA may be compensated by careful attention to intra-operative visual and palpatory assessment.

Interleukin-17 and interleukin-23 are elevated in serum and cerebrospinal fluid of patients with ALS: a reflection of Th17 cells activation?

BACKGROUND: There is evidence that immunological factors may involved in pathogenetic mechanisms of amyotrophic lateral sclerosis (ALS). Th17 cells are characterized by predominant production of IL-17 and are suggested to be crucial in destructive autoimmunity. Interleukin-23 (IL-23) appears to play a supporting role in the continued stimulation and survival of Th17. PATIENTS AND METHODS: We measured by enzyme-like immunosorbent assay (ELISA) serum and cerebrospinal fluid (CSF) levels of IL-17 and IL-23 in 22 patients with ALS and 19 patients with other non-inflammatory neurological disorders (NIND) studied as a control group. IL-17 and IL-23 serum and CSF levels were also correlated with duration of the disease, the disability level and the clinical subtype of the disease onset in patients with ALS. RESULTS: IL-17 and IL-23 serum levels were higher in patients with ALS as compared with patients with NIND (P = 0.015 and P = 0.002 respectively). IL-17 and IL-23 CSF levels were also increased in patients with ALS (P = 0.0006 and P = 0.000001 respectively). IL-17 and IL-23 levels were not correlated with disease duration, disability scale or clinical subtype of the disease onset in ALS patients. CONCLUSIONS: Our findings suggest that these molecules may be involved in the pathogenetic mechanisms acting as potential markers of Th17 cells activation in ALS.

Pimecrolimus cream 1% for the treatment of papulopustular eruption related to epidermal growth factor receptor inhibitors: a case series and a literature review of therapeutic approaches.

BACKGROUND: Cutaneous side effects of epidermal growth factor receptor inhibitors (EGFRIs) are very frequent and well known. The aim of our study was to investigate the efficacy and safety of pimecrolimus 1% cream in the treatment of papulopustular eruption caused by EGFRIs and to review the relevant literature on therapeutic approaches. METHODS: Twenty cancer patients being treated with EGFRIs were included in the study. Nine of the patients showed grade 1 and 11 showed grade 2 papulopustular eruption. All patients were treated with pimecrolimus 1% cream, which was applied twice daily. Patients with grade 2 eruption also received systemic minocycline 100 mg/day. RESULTS: All patients with grade 1 eruption responded to treatment, with 4/9 experiencing complete resolution of the lesions 2 weeks after the initiation of treatment. Five out of 11 patients with grade 2 eruption had more than 50% improvement in erythema and pustules, and 1 had complete resolution of the skin lesions. Two patients did not respond to treatment but were significantly improved after substitution of pimecrolimus 1% cream with metronidazole 1% cream. No side effects were recorded. CONCLUSIONS: Our case series shows that pimecrolimus cream may be an effective and safe approach in the management of papulopustular eruption related to EGFRIs.

Circulating interleukin-10 and interleukin-12 in Parkinson's disease.

BACKGROUND: Interleukin (IL)-12 is a heterodimeric cytokine produced by activated blood monocytes, macrophages and glial cells. It enhances differentiation and proliferation of T cells and increases production of proinflammatory cytokines. IL-10 is a pleiotropic cytokine produced by both lymphocytes and mononuclear phagocytes including microglia. Recent studies demonstrated the neuroprotective effect of IL-10. There is little information about the involvement of IL-12 or IL-10 in the pathophysiology of Parkinson's disease (PD). OBJECTIVES: The objective of our study was to assess the role of IL-12 as a potential marker of immune reactions in patients with PD and to investigate whether IL-10, an immunosuppressive cytokine, may have a neuroprotective effect in the pathogenesis of PD. PATIENTS AND METHODS: We measured using immunoassay serum IL-12 and IL-10 levels in 41 patients with PD in comparison with serum levels in 19 healthy subjects (controls) age and sex matched. IL-12 and IL-10 levels were tested for correlation with sex, age, disease duration, Hoehn and Yahr stage and the UPDRS III score. RESULTS: The PD group presented with significantly increased IL-10 levels when compared with the control group (P = 0.02). The increase observed was not affected by the treatment status. A strong and significant correlation between IL-10 and IL-12 levels was observed in patients with PD (R(S) = 0.7, P < 0.000001). CONCLUSIONS: Our findings suggest that IL-10 may be involved in the pathogenetic mechanisms of PD. The elevation of IL-10 and the significant correlation between IL-10 and IL-12, a proinflammatory cytokine, may suggest that immunological disturbances and neuroprotective mechanisms are involved in patients with PD.