Positivity of celiac disease-specific antibodies and non-celiac hypersensitivity in psoriasis.

INTRODUCTION: Plaque psoriasis and celiac disease are multisystemic diseases. The association of psoriasis and enteropathy with histological changes similar to celiac disease has already been described, and it has also been found that a gluten-free diet improves psoriatic changes. This study assesses the relationship between celiac disease antibodies and psoriasis. METHODS: The study included 112 participants: 60 with psoriasis in a test group and 52 healthy subjects in a control group. Within the psoriasis group, participants were further divided into two subgroups: one consisting of patients with both psoriasis and psoriatic arthritis (n = 17) and another comprising patients with psoriasis alone (n = 43). After informed consent was obtained, the Dermatology Life Quality Index (DLQI) score and Psoriasis Area and Severity Index (PASI) score were evaluated. Laboratory tests included assessment of anti-deaminated gliadin peptide antibodies (DGP), anti-gliadin antibodies (AGA), and anti-tissue transglutaminase antibodies (tTG). RESULTS: Immunoglobulin G (IgG) and immunoglobulin A (IgA) DGP antibodies were detected more frequently and at higher serum concentrations in patients with psoriasis compared to healthy controls (p = 0.03, p = 0.04, respectively). Similarly, elevated levels of IgG-tTG antibodies (p = 0.003) and IgA-DGP antibodies (p = 0.02) were observed in the same test group. CONCLUSIONS: A relationship between positivity to celiac disease antibodies and psoriasis, particularly with regard to AGA, has been identified. Further studies are required to elucidate the nature, pathophysiology, and significance of these findings.

First-year nursing students' attitudes towards artificial intelligence: Cross-sectional multi-center study.

AIM: To assess the attitudes of nursing students toward artificial intelligence. BACKGROUND: Possible applications of artificial intelligence-powered systems in nursing cover all aspects of nursing care, from patient care to risk management. Although the final acceptance of artificial intelligence in practice will depend on positive 'nurses' attitudes toward artificial intelligence, those attitudes have gained little attention so far. DESIGN: A cross-sectional multicenter study. METHODS: The study was performed at nursing schools of four Croatian universities, surveying a total of 336 first-year nursing students (response rate 69.7%) enrolled in 2021. A validated instrument, the General Attitudes towards Artificial Intelligence Scale, consisting of 20 Likert-type items, was chosen for the study. Where applicable, the items were contextualized for nursing. Four sub-scales were identified based on the outcomes of the factor analysis. RESULTS: The average attitude score was (mean ± standard deviation) 64.5 ± 11.7, out of a maximum of 100, which was significantly higher than the neutral score of 60.0 (p < 0.001). The attitude towards AI did not differ across the universities and was not associated with students' age. Male students scored slightly higher than their female colleagues. Scores on subscales "Benefits of artificial intelligence in nursing", "Willingness to use artificial intelligence in nursing practice", and "Dangers of artificial intelligence" were favorable of artificial intelligence-based solutions. However, scores on the subscale "Practical advantages of artificial intelligence" were somewhat unfavorable. CONCLUSIONS: First-year nursing students had slightly positive attitudes towards artificial intelligence in nursing, which should make it easier for the new generations of nurses to embrace and implement artificial intelligence systems. Reservations about artificial intelligence in daily nursing practice indicate that nursing students might benefit from education focused specifically on applications of artificial intelligence in nursing.

Pain associated with psoriasis: a qualitative study.

BACKGROUND: Pain is a major factor in the psychosocial impact of psoriasis. There is a paucity of qualitative reports of dermatologists' views on psoriasis-related pain. OBJECTIVES: The aim of this study was to explore the views of dermatologists on the presence and importance of pain associated with psoriasis. METHODS: This qualitative study, based on semi-structured interviews, included dermatologists from different cities working in the hospital and private sector in Croatia between May and July, 2022. We collected demographic and occupational data on participants and information about their experiences and attitudes toward psoriasis-related pain. Data were analysed by applying interpretative descriptive and thematic analysis using the 4-stage method for systematic text condensation. RESULTS: We included 19 dermatologists, all women, aged 38 (range: 31 to 63 years). Most dermatologists acknowledged the presence of pain in patients with psoriasis. They indicated that they sometimes do not sufficiently address this pain in daily practice. Some indicated that pain was a neglected symptom in psoriasis, while for others it was not crucial. Most indicated that it is necessary to focus more on psoriasis-related pain in clinical practice, to disambiguate between skin pain and joint pain in psoriatic conditions, and to better educate family physicians about psoriasis-related pain. They emphasized the importance of considering pain during psoriatic patient assessment and management. Further research on psoriasis-related pain was suggested. CONCLUSIONS: More emphasis is needed on psoriasis-related pain for effective management of psoriasis, informing decision-making in the context of patient-centric care and improving the quality of life in patients with psoriasis.

The COVID-19 Pandemic and Recent Earthquake in Zagreb Together Significantly Increased the Disease Severity of Patients with Atopic Dermatitis.

BACKGROUND/OBJECTIVE: Stress may affect patients with atopic dermatitis (AD). The aim of this study was to examine the impact of the COVID-19 pandemic and the earthquake in Zagreb, Croatia (March 2020), on AD patients and their disease severity, symptoms/itch, and perceived stress. METHODS: Our observational cross-sectional study included three groups of AD patients diagnosed by a physician: group 1 (n = 50), who experienced both the pandemic (quarantine) and the earthquake; group 2 (n = 50), who experienced only the pandemic; and group 3 (n = 50), the comparison group, who experienced neither disaster (patients examined 2018-2019). Groups 1 and 2 were examined May-June 2020, immediately after the national lockdown/quarantine. Disease severity (SCORAD), data from the Perceived Stress Scale (PSS), and information on patients' confirmed allergies were recorded for all groups, while groups 1 and 2 additionally completed a questionnaire concerning their disease, hand hygiene, and experience during the pandemic and/or earthquake. RESULTS: The patients exposed to both disasters reported more pronounced AD worsening (p < 0.001; r = 0.388) and more frequent itching (p < 0.001; r = 0.350) than those exposed to the pandemic only. Notably, we found certain differences by gender: during the pandemic, women significantly more frequently washed their hands (81% of women washed "very frequently," while 52% of men washed "quite often") and had significantly higher PSS levels than men (p < 0.05). Concerning allergies, present or absent, during the pandemic, there was no significant difference in SCORAD between groups 1 and 2, neither when analyzed separately for indoor nor for outdoor allergens. The most commonly reported psychological disturbances during the pandemic were concern (46%), anger (18%), anxiety (16%), depression (9%), and increased alcohol, cigarette, and opioid agent use (6%). CONCLUSION: The COVID-19 pandemic together with the earthquake significantly increased disease severity and influenced AD worsening, itching, and psychological disturbances. This indicates that stressful events meaningfully affect the course of AD.

Key Factors in the Complex and Coordinated Network of Skin Keratinization: Their Significance and Involvement in Common Skin Conditions.

The epidermis serves many vital roles, including protecting the body from external influences and healing eventual injuries. It is maintained by an incredibly complex and perfectly coordinated keratinization process. In this process, desquamation is essential for the differentiation of epidermal basal progenitor cells into enucleated corneocytes, which subsequently desquamate through programmed death. Numerous factors control keratinocyte differentiation: epidermal growth factor, transforming growth factor-α, keratinocyte growth factor, interleukins IL-1-ß and IL-6, elevated vitamin A levels, and changes in Ca2+ concentration. The backbone of the keratinocyte transformation process from mitotically active basal cells into fully differentiated, enucleated corneocytes is the expression of specific proteins and the creation of a Ca2+ and pH gradient at precise locations within the epidermis. Skin keratinization disorders (histologically characterized predominantly by dyskeratosis, parakeratosis, and hyperkeratosis) may be categorized into three groups: defects in the α-helical rod pattern, defects outside the α-helical rod domain, and disorders of keratin-associated proteins. Understanding the process of keratinization is essential for the pathogenesis of many dermatological diseases because improper desquamation and epidermopoiesis/keratinization (due to genetic mutations of factors or due to immune pathological processes) can lead to various conditions (ichthyoses, palmoplantar keratodermas, psoriasis, pityriasis rubra pilaris, epidermolytic hyperkeratosis, and others).

MINERAL BONE DENSITY AND VITAMIN D LEVELS IN PATIENTS WITH PSORIATIC ARTHRITIS.

The objective of this study was to explore the possible differences in bone mass density (BMD) and markers of bone metabolism between patients with psoriasis with concomitant psoriatic arthritis (PsA) and patients with psoriasis only (PV). A comparable sample of both types of patients were included in analysis. In all patients, vitamin D serum levels along with inflammatory markers and parathyroid hormone (PTH) were measured. BMD was assessed with dual-energy x-ray absorptiometry scan in axial and appendicular skeleton. Patients with PsA tended to have decreased BMD in axial skeleton, while BMD in appendicular skeleton was comparable between the groups. No statistically significant correlation was found of inflammatory markers, vitamin D and PTH levels with BMD in either patient group. A negative correlation was recorded between vitamin D serum concentration and PTH levels.

Ethical, legal, and social considerations of AI-based medical decision-support tools: A scoping review.

INTRODUCTION: Recent developments in the field of Artificial Intelligence (AI) applied to healthcare promise to solve many of the existing global issues in advancing human health and managing global health challenges. This comprehensive review aims not only to surface the underlying ethical and legal but also social implications (ELSI) that have been overlooked in recent reviews while deserving equal attention in the development stage, and certainly ahead of implementation in healthcare. It is intended to guide various stakeholders (eg. designers, engineers, clinicians) in addressing the ELSI of AI at the design stage using the Ethics by Design (EbD) approach. METHODS: The authors followed a systematised scoping methodology and searched the following databases: Pubmed, Web of science, Ovid, Scopus, IEEE Xplore, EBSCO Search (Academic Search Premier, CINAHL, PSYCINFO, APA PsycArticles, ERIC) for the ELSI of AI in healthcare through January 2021. Data were charted and synthesised, and the authors conducted a descriptive and thematic analysis of the collected data. RESULTS: After reviewing 1108 papers, 94 were included in the final analysis. Our results show a growing interest in the academic community for ELSI in the field of AI. The main issues of concern identified in our analysis fall into four main clusters of impact: AI algorithms, physicians, patients, and healthcare in general. The most prevalent issues are patient safety, algorithmic transparency, lack of proper regulation, liability & accountability, impact on patient-physician relationship and governance of AI empowered healthcare. CONCLUSIONS: The results of our review confirm the potential of AI to significantly improve patient care, but the drawbacks to its implementation relate to complex ELSI that have yet to be addressed. Most ELSI refer to the impact on and extension of the reciprocal and fiduciary patient-physician relationship. With the integration of AIbased decision making tools, a bilateral patient-physician relationship may shift into a trilateral one.

Atopic Dermatitis Severity, Patient Perception of the Disease, and Personality Characteristics: How Are They Related to Quality of Life?

INTRODUCTION: Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin condition that greatly affects patients' quality of life, psychological condition, and social relationships. MATERIALS AND METHODS: To analyze different aspects of AD patients' quality of life, we used the SCORing Atopic Dermatitis (SCORAD) index (for AD severity), the Dermatology Life Quality Index (DLQI), the World Health Organization Quality of Life Brief Version (WHOQOL-BREF), the Brief Illness Perception Questionnaire (Brief IPQ), and the Crown-Crisp Experiential Index (CCEI) to analyze personality traits. The study included 84 AD patients, 42 with clinical manifestations and 42 in remission. RESULTS: SCORAD values correlated positively and linearly with DLQI (r = 0.551; p < 0.001) and with disease impact on life, disease control, and disease symptoms (r = 0.350-0.398; p ≤ 0.023). DLQI was also related to certain personality characteristics (free-floating anxiety disorder, obsession, somatization, and depression (p ≤ 0.032)). Symptomatic AD patients had a significantly more impaired DLQI than asymptomatic patients (p < 0.001) and the two groups differed in some IPQ dimensions, but they did not differ significantly concerning the WHOQOL-BREF dimensions and personality traits (CCEI). CONCLUSION: Since AD patient quality of life was dependent not only on disease severity but was also influenced by patient personality characteristics (anxiety disorder, obsession, somatization, depression), many factors need to be taken into account to create effective, patient-specific therapy regimens.

Topical benzoyl peroxide for acne.

BACKGROUND: Acne is a common, economically burdensome condition that can cause psychological harm and, potentially, scarring. Topical benzoyl peroxide (BPO) is a widely used acne treatment; however, its efficacy and safety have not been clearly evaluated. OBJECTIVES: To assess the effects of BPO for acne. SEARCH METHODS: We searched the following databases up to February 2019: the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We also searched five trials registers and checked the reference lists of relevant randomised controlled trials (RCTs) and systematic reviews. SELECTION CRITERIA: We included RCTs that compared topical BPO used alone (including different formulations and concentrations of BPO) or as part of combination treatment against placebo, no treatment, or other active topical medications for clinically diagnosed acne (used alone or in combination with other topical drugs not containing BPO) on the face or trunk. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures as expected by Cochrane. Primary outcome measures were 'participant global self-assessment of acne improvement' and 'withdrawal due to adverse events in the whole course of a trial'. 'Percentage of participants experiencing any adverse event in the whole course of a trial' was a key secondary outcome. MAIN RESULTS: We included 120 trials (29,592 participants randomised in 116 trials; in four trials the number of randomised participants was unclear). Ninety-one studies included males and females. When reported, 72 trials included participants with mild to moderate acne, 26 included participants with severe acne, and the mean age of participants ranged from 18 to 30 years. Our included trials assessed BPO as monotherapy, as add-on treatment, or combined with other active treatments, as well as BPO of different concentrations and BPO delivered through different vehicles. Comparators included different concentrations or formulations of BPO, placebo, no treatment, or other active treatments given alone or combined. Treatment duration in 80 trials was longer than eight weeks and was only up to 12 weeks in 108 trials. Industry funded 50 trials; 63 trials did not report funding. We commonly found high or unclear risk of performance, detection, or attrition bias. Trial setting was under-reported but included hospitals, medical centres/departments, clinics, general practices, and student health centres. We reported on outcomes assessed at the end of treatment, and we classified treatment periods as short-term (two to four weeks), medium-term (five to eight weeks), or long-term (longer than eight weeks). For 'participant-reported acne improvement', BPO may be more effective than placebo or no treatment (risk ratio (RR) 1.27, 95% confidence interval (CI) 1.12 to 1.45; 3 RCTs; 2234 participants; treatment for 10 to 12 weeks; low-certainty evidence). Based on low-certainty evidence, there may be little to no difference between BPO and adapalene (RR 0.99, 95% CI 0.90 to 1.10; 5 RCTs; 1472 participants; treatment for 11 to 12 weeks) or between BPO and clindamycin (RR 0.95, 95% CI 0.68 to 1.34; 1 RCT; 240 participants; treatment for 10 weeks) (outcome not reported for BPO versus erythromycin or salicylic acid). For 'withdrawal due to adverse effects', risk of treatment discontinuation may be higher with BPO compared with placebo or no treatment (RR 2.13, 95% CI 1.55 to 2.93; 24 RCTs; 13,744 participants; treatment for 10 to 12 weeks; low-certainty evidence); the most common causes of withdrawal were erythema, pruritus, and skin burning. Only very low-certainty evidence was available for the following comparisons: BPO versus adapalene (RR 1.85, 95% CI 0.94 to 3.64; 11 RCTs; 3295 participants; treatment for 11 to 24 weeks; causes of withdrawal not clear), BPO versus clindamycin (RR 1.93, 95% CI 0.90 to 4.11; 8 RCTs; 3330 participants; treatment for 10 to 12 weeks; causes of withdrawal included local hypersensitivity, pruritus, erythema, face oedema, rash, and skin burning), erythromycin (RR 1.00, 95% CI 0.07 to 15.26; 1 RCT; 60 participants; treatment for 8 weeks; withdrawal due to dermatitis), and salicylic acid (no participants had adverse event-related withdrawal; 1 RCT; 59 participants; treatment for 12 weeks). There may be little to no difference between these groups in terms of withdrawal; however, we are unsure of the results because the evidence is of very low certainty. For 'proportion of participants experiencing any adverse event', very low-certainty evidence leaves us uncertain about whether BPO increased adverse events when compared with placebo or no treatment (RR 1.40, 95% CI 1.15 to 1.70; 21 RCTs; 11,028 participants; treatment for 10 to 12 weeks), with adapalene (RR 0.71, 95% CI 0.50 to 1.00; 7 RCTs; 2120 participants; treatment for 11 to 24 weeks), with erythromycin (no participants reported any adverse events; 1 RCT; 89 participants; treatment for 10 weeks), or with salicylic acid (RR 4.77, 95% CI 0.24 to 93.67; 1 RCT; 41 participants; treatment for 6 weeks). Moderate-certainty evidence shows that the risk of adverse events may be increased for BPO versus clindamycin (RR 1.24, 95% CI 0.97 to 1.58; 6 RCTs; 3018 participants; treatment for 10 to 12 weeks); however, the 95% CI indicates that BPO might make little to no difference. Most reported adverse events were mild to moderate, and local dryness, irritation, dermatitis, erythema, application site pain, and pruritus were the most common. AUTHORS' CONCLUSIONS: Current evidence suggests that BPO as monotherapy or add-on treatment may be more effective than placebo or no treatment for improving acne, and there may be little to no difference between BPO and either adapalene or clindamycin. Our key efficacy evidence is based on participant self-assessment; trials of BPO versus erythromycin or salicylic acid did not report this outcome. For adverse effects, the evidence is very uncertain regarding BPO compared with adapalene, erythromycin, or salicylic acid. However, risk of treatment discontinuation may be higher with BPO compared with placebo or no treatment. Withdrawal may be linked to tolerability rather than to safety. Risk of mild to moderate adverse events may be higher with BPO compared with clindamycin. Further trials should assess the comparative effects of different preparations or concentrations of BPO and combination BPO versus monotherapy. These trials should fully assess and report adverse effects and patient-reported outcomes measured on a standardised scale.

Fas receptor induces apoptosis of synovial bone and cartilage progenitor populations and promotes bone loss in antigen-induced arthritis.

Rheumatoid arthritis (RA) is an inflammatory joint disease that eventually leads to permanent bone and cartilage destruction. Fas has already been established as the regulator of inflammation in RA, but its role in bone formation under arthritic conditions is not completely defined. The aim of this study was to assess the effect of Fas inactivation on the bone damage during murine antigen-induced arthritis. Subchondral bone of wild-type (WT) and Fas-knockout (Fas-/-) mice was evaluated by histomorphometry and microcomputerized tomography. Proportions of synovial bone and cartilage progenitors were assessed by flow cytometry. Synovial bone and cartilage progenitors were purified by fluorescence-activated cell sorting and expression of Fas and Fas-induced apoptosis were analyzed in vitro. Results showed that Fas-/- mice developed attenuated arthritis characterized by preserved epiphyseal bone and cartilage. A proportion of the earliest CD200+ bone and cartilage progenitors was reduced in WT mice with arthritis and was unaltered in Fas-/- mice. During osteoblastic differentiation in vitro, CD200+ cells express the highest levels of Fas and are removed by Fas ligation. These results suggest that Fas-induced apoptosis of early CD200+ osteoprogenitor population represents potential mechanism underlying the impaired bone formation in arthritis, so their preservation may represent the bone-protective mechanism during arthritis.-Lazic Mosler, E., Lukac, N., Flegar, D., Fadljevic, M., Radanovic, I., Cvija, H., Kelava, T., Ivcevic, S., Sucur, A., Markotic, A., Katavic, V., Marusic, A., Grcevic, D., Kovacic, N. Fas receptor induces apoptosis of synovial bone and cartilage progenitor populations and promotes bone loss in antigen-induced arthritis.

Inflammatory epidermolysis bullosa acquisita in a 4-year-old girl.

This study presents a case of linear immunoglobulin A dermatosis-like epidermolysis bullosa acquisita in a 4-year-old girl showing rapid, widespread and inflammatory skin lesions. The diagnosis was confirmed by histopathology, direct and indirect immunofluorescence, various immunoblotting analyses and enzyme-linked immunosorbent assays. Despite the severe clinical manifestations, the disease was successfully controlled by combination therapy of oral prednisolone and dapsone.