Transient plasma viral rebound after SARS-CoV-2 vaccination in an exceptional HIV-1 elite controller woman.

BACKGROUND: Elite controllers are able to control viral replication without antiretroviral therapy. Exceptional elite controllers do not show disease progression for more than 25 years. Different mechanisms have been proposed and several elements of both innate and adaptive immunity are implicated. Vaccines are immune stimulating agents that can promote HIV-RNA transcription; transient plasma HIV-RNA detectability has been described within 7-14 days after different vaccinations. The most reliable mechanism involved in virosuppressed people living with HIV is a generalized inflammatory response that activates bystander cells harboring latent HIV. So far no data about viral load increase in elite controllers after SARS-CoV-2 vaccination are reported in literature. CASE PRESENTATION: We report the case of a 65-year-old woman of European ancestry, diagnosed with HIV-1/HCV co-infection more than 25 years ago. Since then, HIV-RNA remained undetectable and she never received ARV therapy. In 2021 she was vaccinated with mRNA-BNT162b2 vaccine (Pfizer-BioNTech®). She was administered with three doses in June, July and October 2021, respectively. The last available viral load was undetectable in March 2021. We observed an increase of VL at 32 cp/ml and 124 cp/mL, two and seven months after the second vaccine dose, respectively. During monthly follow-up, HIV-RNA gradually and spontaneously dropped becoming undetectable without ARV intervention. COVID-19 serology was positive with IgG 535 BAU/mL, showing response to vaccination. We measured total HIV-DNA at different time-points and we found it detectable both at the time of the higher plasma HIV-RNA (30 cp/10^6 PBMCs) and when it was undetectable (13 cp/10^6 PBMCs), in reduction. CONCLUSIONS: This case is the first report, to our knowledge, describing a rebound of plasma HIV-RNA in an elite controller after three doses of mRNA-BNT162b2 vaccine for SARS-CoV-2. Concomitantly with a spontaneous reduction of plasma HIV-RNA ten months after the third dose of mRNA-BNT162b2 vaccine (Pfizer-BioNTech®) without antiretroviral therapy intervention, we observed a reduction of total HIV-DNA in peripheral mononuclear cells. The potential role of vaccinations in altering HIV reservoir, even in elite controllers when plasma HIV-RNA is undetectable, could be a valuable aspect to take into account for the future HIV eradication interventions.

Acute and chronic nociceptive phases observed in a rat hind paw ischemia/reperfusion model depend on different mechanisms.

Complex regional pain syndrome type 1 (CRPS1) may be evoked by ischemia/reperfusion, eliciting acute and chronic pain that is difficult to treat. Despite this, the underlying mechanism of CRPS1 has not been fully elucidated. Therefore, the goal of this study is to evaluate the involvement of inflammation, oxidative stress, and the transient receptor potential ankyrin 1 (TRPA1) channel, a chemosensor of inflammation and oxidative substances, in an animal model of chronic post-ischemia pain (CPIP). Male Wistar rats were subjected to 3 h hind paw ischemia/reperfusion (CPIP model). Different parameters of nociception, inflammation, ischemia, and oxidative stress were evaluated at 1 (acute) and 14 (chronic) days after CPIP. The effect of a TRPA1 antagonist and the TRPA1 immunoreactivity were also observed after CPIP. In the CPIP acute phase, we observed mechanical and cold allodynia; increased levels of tumor necrosis factor-α (hind paw), ischemia-modified albumin (IMA) (serum), protein carbonyl (hind paw and spinal cord), lactate (serum), and 4-hydroxy-2-nonenal (4-HNE, hind paw and spinal cord); and higher myeloperoxidase (MPO) and N-acetyl-ß-D-glucosaminidase (NAGase) activities (hind paw). In the CPIP chronic phase, we detected mechanical and cold allodynia and increased levels of IMA (serum), protein carbonyl (hind paw and spinal cord), and 4-HNE (hind paw and spinal cord). TRPA1 antagonism reduced mechanical and cold allodynia 1 and 14 days after CPIP, but no change in TRPA1 immunoreactivity was observed. Different mechanisms underlie acute (inflammation and oxidative stress) and chronic (oxidative stress) phases of CPIP. TRPA1 activation may be relevant for CRPS1/CPIP-induced acute and chronic pain.

Metastatic volume: an old oncologic concept and a new prognostic factor for stage IV melanoma patients.

BACKGROUND: The last melanoma staging system of the 2009 American Joint Committee on Cancer takes into account, for stage IV disease, the serum levels of lactate dehydrogenase (LDH) and the site of distant metastases. OBJECTIVE: Our aim was to compare the significance of metastatic volume, as evaluated at the time of stage IV melanoma diagnosis, with other clinical predictors of prognosis. METHODS: We conducted a retrospective multicentric study. To establish which variables were statistically correlated both with death and survival time, contingency tables were evaluated. The overall survival curves were compared using the Kaplan-Meier method. RESULTS: Metastatic volume and number of affected organs were statistically related to death. In detail, patients with a metastatic volume >15 cm(3) had a worse prognosis than those with a volume lower than this value (survival probability at 60 months: 6.8 vs. 40.9%, respectively). The Kaplan-Meier method confirmed that survival time was significantly related to the site(s) of metastases, to elevated LDH serum levels and to melanoma stage according to the latest system. CONCLUSION: Our results suggest that metastatic volume may be considered as a useful prognostic factor for survival among melanoma patients.

Analysis of diagnostic criteria in adamantiades-behçet disease: a retrospective study.

Adamantiades-Behçet's disease (ABD) is a chronic-relapsing, inflammatory and multi-systemic disease. Any organ or system may be involved: ABD presents a great variety of cutaneous and mucosal lesions, ocular manifestations, central and peripheral nervous system abnormalities, joint as well as gastrointestinal involvement. Since clear pathognomonic clinical features and laboratory tests are lacking, the diagnosis of ABD mainly relies on the characteristic clinical features. Several sets of diagnostic criteria have been used. The International Study Group for Behçet Disease (ISGBD) in 1990 formulated a set of criteria to warrant uniformity of both diagnosis and classification. Therefore, in 2006, a new set was proposed by the International Team for the Revision of the International Criteria for Behçet's Disease (ITR-ICBD) not only to uniform the previous criteria but also to establish best accuracy, along with an optimum sensivity and specificity. The aims of this study are both to analyze the clinical features of ABD patients and to validate the ISGBD and ITR-ICDB criteria for the diagnosis of ABD in our cohort.

Psoriasis vulgaris does not adversely influence the quality of sleep.

AIM: Sleep could be severely affected in psoriasis because of skin symptoms and psychological repercussions of the disease. The aim of this study was to investigate the influence of psoriasis on sleep. METHODS: A total of 202 patients with psoriasis and 202 healthy volunteers have completed a self-rated questionnaire, the Pittsburgh Sleep Quality Index, which assesses sleep quality and disturbances over a 1-month time interval. The severity of the dermatoses has been evaluated utilizing the PASI score. RESULTS: In psoriatic patients the Pittsburgh Sleep Quality Index resulted between 0 and 17 (5.56±3.93), in the controls between 0 and 18 (5.13±4.16). No statistically significant correlation was observed between the score of Pittsburgh Sleep Quality Index and PASI. The anti-psoriatic therapy, while causing a marked improvement of lesions and itching, does not affect the quality of sleep. CONCLUSION: Although literature indicated that psoriasis negatively affects the quality of sleep, in this study this correlation was not observed.

Involvement of the glutamatergic system in the nociception induced intrathecally for a TRPA1 agonist in rats.

The transient receptor potential ankyrin 1 (TRPA1) is expressed in peripheral and spinal terminals of sensory neurons, jointly to the vanilloid receptor (TRPV1). A relevant peripheral role of TRPA1 receptor has been implicated in a variety of processes, including the detection of noxious cold, and diverse painful stimulus, but the functional role of TRPA1 receptor in nociceptive transmission at spinal cord in vivo is poorly known. Therefore, the aim of this study was to evaluate whether the glutamatergic system is involved in the transmission of nociceptive stimulus induced for a TRPA1 agonist in the rat spinal cord. We observed that cinnamaldehyde, a TRPA1 agonist, on spinal cord synaptosomes leads to an increase in [Ca(2+)](i) and a rapid release of glutamate, but was not able to change the specific [(3)H]-glutamate binding. In addition, spinally administered cinnamaldehyde produced heat hyperalgesia and mechanical allodynia in rats. This behavior was reduced by the co-injection (i.t.) of camphor (TRPA1 antagonist) or MK-801 (N-methyl-D-aspartate (NMDA) receptor antagonist) to cinnamaldehyde. Besides, the pretreatment with resiniferatoxin (RTX), a potent TRPV1 agonist, abolished the cinnamaldehyde-induced heat hyperalgesia. Here, we showed that intrathecal RTX results in a decrease in TRPA1 and TRPV1 immunoreactivity in dorsal root ganglion. Collectively, our results demonstrate the pertinent participation of spinal TRPA1 in the possible enhancement of glutamatergic transmission of nociceptive signals leading to increase of the hypersensitivity, here observed as heat hyperalgesia. Then the modulation of spinal TRPA1 might be a valuable target in painful conditions associated with central pain hypersensitivity.

Renal leiomyoma.

Renal leiomyomas are rare benign tumours, which are usually small in size and incidentally discovered in most of cases. We report a case of giant renal leiomyoma encasing the right kidney in a 55 year old lady. We review the spectrum of features seen in reported leiomyomas on imaging and gross appearance. We discuss the differential diagnosis and highlight the fact that renal leiomyoma, although rare, must be considered in the differential diagnosis of spindle cell lesions of the kidney and that this tumour may present as a huge renal mass.

[Minimally invasive video-assisted parathyroidectomy and intraoperative parathyroid hormone monitoring]. / Paratiroidectomia mini-invasiva video-assistita e monitoraggio intraoperatorio del paratormone.

BACKGROUND: Aim of this study is to analyze our preliminary results from minimally invasive video-assisted parathyroidectomy (MIVAP) and to evaluate the clinical impact of intraoperative measurements of intact parathyroid hormone (PTHIO). PATIENTS AND METHODS: MIVAP by an anterior approach was proposed for patients with sporadic primary hyperparathyroidism pHPT and one unequivocally enlarged parathyroid gland on preoperative ultrasound and 99mTc-SestaMIBI scintigraphy. We used an operative technique first described by Miccoli in 1997, without carbon dioxide insufflation. Quick parathyroid hormone immunochemiluminometric assay (qPTHa) was performed intraoperatively during all surgical procedures. Age, operative times, pathologic findings, postoperative pain, calcemia, length of hospital stay, cosmetic results, and complications were retrospectively analyzed. RESULTS: From October 2006 to December 2009, MIVAP was proposed for 28 of 40 (70%). Mean operative time was 65 minutes. Postoperative complications included 4 (12.9%) transient hypocalcemia and one (3.22%) transient nerve palsy with complete recovery. No definitive laryngeal nerve palsies, no definitive hypocalcemias, no persistent pHPT and no recurrent pHPT were observed. The cosmetic result was excellent in all cases. CONCLUSIONS: Our preliminary results demonstrate that MIVAP for localized single-gland adenoma, after adequate training, seems to be feasible with significant advantages, especially in terms of cosmetic results, postoperative pain, and postoperative recovery, if performed by dedicated team, with a sufficient and specific activity volume.

Pulmonary sarcoidosis in a patient with psoriatic arthritis during infliximab therapy.

The occurrence of sarcoidosis during anti-TNF-alpha therapy has occasionally been published. We report the case of a psoriasis patient who developed pulmonary sarcoidosis during a cycle of therapy with infliximab.

Anal canal and rectal condylomatosis: exhaustive proctological examination and STD patients.

Infection of the anorectal area with some subtypes of HPV virus results in local involvement that appears as warty, papillary, condylomatous lesions. Patients exposed to high-risk HPV types, such as HPV-16, -18, and -31, are at risk for developing high-grade dysplasias or carcinomas. We reviewed 15 years (1991 - 2006) of patient records from our proctological unit and STD center and found 1,122 patients affected by anorectal condylomatosis. This study supports the importance of an exhaustive proctological examination in patients suffering from condylomatosis of the genital area, especially of the perianal zone, and in patients examined in the STD clinic, even for other reasons. An unknown anorectal condylomatosis is a frequent cause of relapse of anogenital warts. Anal warts should be examined by proctoscopy to assess the full extent of the lesions and prevent possible complications.

The east-west advancement flap (horizontal advancement flap) to repair a defect on the nose ala.

BACKGROUND: The repair of an alar nasal defect is a frequent challenge for dermatologic surgeons for reasons of the high rate of non-melanoma cancers in the area. OBJECTIVE: Our aim was to describe the use of an east-west cheek-based flap (horizontal advancement flap) to repair a surgical defect on the nose ala. METHODS: Benefits and limits of this surgical procedure are evaluated. RESULT: The resulting S-shaped scar was well-camouflaged among the natural skin lines (melolabial fold and melonasal junction). No architectural distortion of the nose resulted from the procedure. CONCLUSION: In selected patients with small-to-medium-size defects of the nasal ala, the horizontal advancement flap is a simple, reliable and aesthetic reconstruction option.

A "skin helix" flap to correct circular skin loss on the nasal ala.

The surgical treatment of circular skin defects localized on the nasal ala is always extremely challenging. Such lesions can be repaired by using full-thickness skin graft or skin flaps, normally with poor aesthetic outcomes. Skin grafts do not achieve satisfactory aesthetic results because of the unnatural look of the transplanted skin. If a skin flap is chosen, the choice of which one to employ among the many available must be made very carefully in order to obtain the best possible aesthetic outcome. This article describes the clinical case of a localized tumor on the nasal right ala that was surgically removed and satisfactorily treated by employing a "skin helix flap."

Dermoscopy of eccrine acrospiroma masquerading as nodular malignant melanoma.

Eccrine acrospiroma, better known as eccrine poroma, is a benign adnexal neoplasm of the skin. Its clinical aspect can masquerade as some other nodular and cystic lesions. The current dermoscopy literature offers very few case studies. Moreover, these very few examples present a totally different appearance pattern compared to the one we examined. Its homogeneous blue pattern suggested the better-known nodular malignant melanoma; in fact, this dermoscopic appearance was due to the Tyndall effect.

Non-randomized pilot study on the evaluation of the quality of life and psychosocial stress before and after systemic therapy in patients affected by moderate to severe psoriasis.

Psoriasis has a major impact on patients? lives, affecting them physically, psychologically and socially. The aim of this study is to investigate psoriasis in relation to quality of life and psychological stress in two groups of patients treated with biologics and narrow-band UVB, respectively. We conducted a nonrandomized, prospective, comparative pilot study on 40 patients suffering from moderate to severe psoriasis. The comparison of the delta score of Skindex-29, Psoriasis Life Stress Inventory and the PASI at baseline and at the end of the treatment in the two groups highlighted the variation of the Psoriasis Life Stress Inventory which resulted significantly higher (P<0.001) in the group treated with biologics. The ease of administrating the combination Etanercept and Efalizumab, with consequent reduction of stress levels, attains a better control of psoriasis compared to phototherapy.