Neurotrophin-4 and Brain-Derived Neurotrophic Factor Serum Levels in Renal Transplant Recipients with Chronic Pruritus.

INTRODUCTION: Chronic pruritus (CP) is a common symptom defined as a sensation that provokes the desire to scratch and which lasts for at least 6 weeks. CP remains a problem for up to 21.3% of renal transplant recipients (RTRs). Our research aimed to establish the possible association between serum levels of neurotrophin-4 (NT-4) and brain-derived neurotrophic factor (BDNF) and the presence and intensity of CP in RTR. METHODS: The study was performed on a group of 129 RTRs, who were divided according to the presence or absence of pruritus in the previous 3 days. The assessment of pruritus was performed with the use of a numeric rating scale (NRS), 4-Item Itch Questionnaire (4IIQ), and Itchy Quality of Life (Itchy QoL). A total of 129 blood samples with a volume of 9 ml were drawn from RTRs during the monthly routine control. Serum levels (pg/mL) of NT-4 and BDNF were measured by the ELISA. RESULTS: Pruritic RTRs have statistically significantly higher serum concentrations of NT-4 serum level compared to non-pruritic RTRs (229.17 ± 143.86 pg/mL and 153.08 ± 78.19 pg/mL [p = 0.024], respectively). Moreover, a statistically significant difference between pruritic and non-pruritic RTRs with healthy controls was shown (p < 0.001 and p < 0.001, respectively). Although there was a numerically higher serum concentration of BDNF in pruritic RTRs (32.18 ± 7.31 pg/mL vs. 31.58 ± 10.84 pg/mL), the difference did not reach statistical significance. No statistically significant difference was also seen in BDNF serum levels between RTRs and healthy controls. Furthermore, there was a statistically significant, positive correlation between serum concentration of NT-4 and NRS score (p = 0.008, r = 0.357). CONCLUSIONS: The results indicate higher NT-4 serum concentration in RTRs with pruritus compared to RTRs without pruritus. Furthermore, the study revealed a statistically significant, positive correlation between the serum concentration of NT-4 and NRS score.

Rheumatoid arthritis - medication dosage in chronic kidney disease.

Renal failure in the course of rheumatoid arthritis (RA) is a consequence of many factors, including drug-induced nephrotoxicity, comorbidities and chronic inflammation. Contemporary treatment strategies have reduced the incidence of renal failure in the population of RA patients. However, it remains a problem for approximately 25% of patients. Therefore, special attention should be paid to the potential need for dosage modifications of administered medications. Many drugs used in the therapy of rheumatic diseases have not been thoroughly studied for their safety in patients with reduced glomerular filtration, resulting in limited data in this area. The establishment of precise, transparent, and consistent dosage recommendations for antirheumatic drugs in chronic kidney disease would significantly facilitate the care of patients with RA. The following review provides a general summary of the available knowledge regarding the dosage of rheumatic medications in renal insufficiency and aims to highlight the need for further research in this area.

High Serum IL-31 Concentration Is Associated with Itch among Renal Transplant Recipients.

Chronic itch (CI) is a common symptom caused by both dermatological and systemic disorders. CI is also a frequent, burdensome symptom among renal transplant recipients (RTR); however, its pathophysiology is not fully understood. The aim of this study was to assess the differences in concentration of IL-31 among itchy RTR. The study was performed on a group of selected 129 RTRs (54 itchy and 75 non-itchy patients). Itch severity was assessed with the use of the numeral rating scale (NRS) and the 4-item itch questionnaire (4IIQ). Every subject had his blood drawn to measure the concentration of IL-31. The results were subsequently compared and correlated. The mean concentration differed significantly between RTR suffering from itch (602.44 ± 534.5 pg/mL), non-itchy RTR (161.49 ± 106.61 pg/mL), and HC (110.33 ± 51.81 pg/mL) (p < 0.001). Post-hoc analysis revealed a statistically significantly increased IL-31 serum concentration in itchy RTR in comparison to the non-itchy RTR group (p < 0.001) and HC (p < 0.001). No significant difference was observed in IL-31 serum levels between non-itchy RTRs and HC. No correlation between IL-31 and itch intensity was found. The results of our study clearly demonstrate the association between IL-31 levels and CI in patients after renal transplantation.

Psychosocial Burden of Itch among Renal Transplant Recipients.

Itch is the most common symptom of chronic dermatoses. Moreover, itch may be associated with systemic disorders. Chronic kidney disease­associated itch (CKD-aI) may affect up to 20% of renal transplant recipients (RTR). The aim of the study was to assess psychosocial burden of itch in RTR. The study was performed on a group of 129 RTR, out of which 54 (41.9%) experienced itch in the previous 3 days. A specially designed questionnaire assessing anxiety, depression, stigmatization, and quality of life was used. Results: Patients suffering from itch in the previous 3 days achieved significantly higher scores in GAD-7 (p < 0.001), BDI (p < 0.001), HADS total score (p < 0.001), HADS Depression (p = 0.004), and HADS Anxiety (p < 0.001). Severity of itch correlated positively with HADS, stigmatization scale, and GAD-7. Itch in RTR was associated with higher incidence of depression assessed with BDI (OR 3.7). Moreover, higher prevalence of anxiety was found among patients suffering from CKD-aI, assessed with HADS A and GAD-7 (OR 2.7 and OR 4.8, respectively) The results of our study clearly demonstrate that itch among RTR is a significant burden. Higher prevalence of depression and anxiety in this groups indicate the necessity of addressing itch relief as a part of holistic approach to patients after renal transplantation.

Safety evaluation of secukinumab in pediatric patients with plaque psoriasis.

INTRODUCTION: Psoriasis (Ps) is a common chronic, recurrent, immune-mediated, inflammatory skin disease affecting up to 2% of children. It has a well-established impact on patients' quality of life. Moreover, patients with psoriasis exhibit a higher prevalence of comorbidities, including hypertension, diabetes, and inflammatory bowel disease. Secukinumab is a fully human monoclonal IL-17A antibody, which has been approved for use in children with psoriasis. Nevertheless, there are very little data on the safety of this therapy in the pediatric population. AREAS COVERED: The aim of this article was to perform an extensive review of available data concerning secukinumab safety and efficiency in the pediatric population used for the treatment of plaque psoriasis. Moreover, special attention was paid to underline the adverse effects of secukinumab. EXPERT OPINION: Although there is very little evidence on the long-term safety of secukinumab use in the pediatric population, this therapy may be a promising modality in children with moderate to severe psoriasis. The available data confirm its favorable safety profile with no serious adverse events and unexpected events. Moreover, the clinical trials revealed sustained efficiency with respect to reaching PASI 75 and decreasing impact of the disease on quality of life.

Nevus Sebaceous with Multiple Basal Cell Carcinomas and Extracutaneous Abnormalities: Genetic Origin or Coincidence?

The association of cutaneous and extracutaneous abnormalities is a common phenomenon, widely described in a variety of genetic syndromes. Nevertheless, yet undescribed syndromic combinations may still exist. Herein we present a case report of a patient who was admitted to the Dermatology Department due to multiple basal cell carcinomas arising from nevus sebaceous. In addition to the cutaneous malignancies, the patient presented with palmoplantar keratoderma, prurigo nodularis, hypothyroidism, multiple lumbar abnormalities, uterine myoma, an ovarian cyst, and highly dysplastic colon adenoma. Such a combination of multiple disorders may indicate a genetic origin of the diseases.

Hidradenitis Suppurativa Quality of Life 24 (HSQoL-24) now available for Polish patients: creation and validation of the Polish language version.

Introduction: Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disorder with a well-documented impact on quality of life (QoL). Due to the very distinctive features of HS the clinical picture, and lack of specific questions, generic dermatology QoL questionnaires cannot adequately reflect patients' suffering. Aim: To translate and validate the Polish version of the Hidradenitis Suppurativa Quality of Life 24 (HSQoL-24) questionnaire. Material and methods: The standardized translation process included forward and backward translation from the English version of the instrument. The final version was subsequently validated on a group of 30 HS patients, who completed the questionnaire twice. Internal consistency, test-retest reliability, and reproducibility of the results were also analysed. Results: The Polish version of HSQoL-24 showed excellent internal consistency, with a Cronbach α coefficient of 0.908. Moreover, excellent reproducibility of the results was observed, with an intraclass correlation coefficient of 0.908. The HSQoL global score correlated positively with Dermatology Life Quality Index (DLQI) and Hidradenitis Suppurativa Quality of Life (HiSQoL) questionnaire. Conclusions: The Polish version of HSQoL-24 has excellent internal consistency, good reproducibility, and adequate validity. It may be of help in assessing QoL impairment in HS patients in daily practice and research.