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1.
Immunotherapy ; 2020 Sep 22.
Artigo em Inglês | MEDLINE | ID: mdl-32957824

RESUMO

Introduction: We report a case of a young female patient, previously affected by psoriatic arthritis, and treated with adalimumab, who developed a chronic spontaneous urticaria and started a concomitant therapy with omalizumab. Methods & results: A 50% reduction of the Dermatology Life Quality Index (from 7 at baseline to 4 in weeks 12 and 24) and a complete reset of the Urticaria Activity Score for 7 days (from 27 at baseline to 0 in weeks 12 and 24) were recorded. During all treatment with omalizumab, administering of adalimumab was continued. Due to complete control of urticaria symptoms, the patient stopped treatment with omalizumab after 24 weeks. Conclusion: The combination of adalimumab and omalizumab could offer a favorable efficacy and safety profile. The synergistic action of the two biological drugs in reducing systemic inflammation could be responsible for a shorter time to obtain clinical response.

3.
Expert Rev Med Devices ; : 1-5, 2020 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-32880493

RESUMO

Lumbosacral disc herniation (LDH) represents the most common cause of sciatica. Currently, there is limited evidence about minimally invasive interventional therapies for the treatment of this condition. This paper presents the protocol for a multicenter, prospective, randomized, controlled, phase III trial evaluating if PRF in addition to TFESI leads to better outcomes in patients with sciatica due to LDH, compared to TFESI alone, during the first year after treatment (Pulsed Radiofrequency in Addition to TFESI for Sciatica [PRATS]). Eligible patients are between 18 and 75 years of age, suffer from sciatica of less than 12-week duration with pain intensity >4 on the Visual Analogue Scale (VAS) and have unilateral LDH compatible with symptoms at MRI. The Medical Ethics Committee of participating hospitals approved the study protocol. Patients will be randomized to receive either combined treatment (PRF and TFESI) or TFESI alone. The primary outcome will be the assessment of pain intensity with VAS at different timepoints from week-1 to 52 after treatment; secondary outcomes will include Roland Disability Questionnaire for sciatica and Oswestry Disability Index, evaluated at 4, 12 and 52 weeks. The follow-up will last 52 weeks for each patient. Statistical analysis will be performed on a per-protocol basis.

5.
Arch Dermatol Res ; 2020 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-32776228

RESUMO

Psoriasis is a multisystemic inflammatory disease with a significant burden in terms of disability and reduced quality of life. The interrelations between disease severity, psychological well-being, and disability and/or health-related quality of life (HRQOL) of psoriatic patients are not fully understood. The aim of the study was to assess the relative role of disease severity, depressive symptoms, and insecure attachment in predicting disability and HRQOL in 105 patients with psoriasis. Objective measures of disease severity included the Body Surface Area (BSA), the Psoriasis Area and Severity Index (PASI), and the Pain Visual Analog Scale (pain-VAS). The Sheehan Disability Scale (SDS). The Dermatology Life Quality Index (DLQI). Multivariate hierarchical regression analysis showed that a preoccupied style of attachment and the presence of depressive symptoms were predictors of disability and HRQOL over and above the contribution of demographic and clinical variables. The inclusion of attachment and depression into multivariate regression models improved substantially the prediction of disability and HRQOL. Conversely, the predictive utility of objective indicators of disease severity was scarce and only the pain-VAS emerged as a significant predictor of disability whereas there were no significant correlations between HRQOL and any of the objective indicators of disease severity. Measures capturing patients' perspectives of the functional impact of disease should be routinely included in the clinical assessment of psoriasis.

6.
Artigo em Inglês | MEDLINE | ID: mdl-32758019

RESUMO

Objective: Q-switched laser is considered a gold standard treatment for Nevus of Ota (NO). We report how few laser sessions in long intervals of time may achieve satisfying outcomes reducing the rate of possible procedure-linked side effects such as burning, cornea injuries, or hyperpigmentation. Background: NO represents a congenital dermal melanocytosis in the trigeminal distribution majorly occurring in Asian individuals. Multiple reports have shown efficacy and safety of Q-switched laser for the treatment of this condition, but they were based on an empiric regimen, often leading to unnecessary overtreatments. At the best of our knowledge, no long-term follow-up observations of single laser sessions have been conducted to assess the proper intervals and number of treatments. Materials and Methods: A 36-year-old Asian woman, Fitzpatrick skin type IV with clinical diagnosis of NO, was treated with 1064 nm 6 ns Q-switched laser one session per year for a total of two sessions. Clinical result was valued by two physicians independently using standardized and polarized light. No use of general anesthesia or sedation was needed in our experience. Corneal shields have been used. Results: After only two sessions of the Q-switched laser performed 1 year apart, the result was excellent with a 95% of clinical response. No side effect was observed. Conclusions: In our experience, Q-switched Nd:YAG laser is an effective treatment for NO with no necessity of high number of treatments. A larger population is needed to confirm this preliminary result.

7.
Chemotherapy ; 65(1-2): 2-10, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32777789

RESUMO

Basal cell carcinoma is the most common skin tumour, with the majority of the cases occurring on the head and neck district, where cosmetic and functional results are crucial. It can be locally destructive if not diagnosed early and treated appropriately. Surgery is the treatment of choice for most lesions, but aggressive, recurrent, or unresectable tumours can be challenging to manage. Advanced basal cell carcinoma includes high recurrence risk subtypes, in which standard therapies demonstrate lack of efficacy. This led to a need for investigating more deeply the pathogenesis of the disease and to the discovery of the implication of the hedgehog pathway. The development of systemic inhibitors of this pathway provides new treatment options for patients with advanced disease, resulting in survival improvement. Food and Drug Administration, before, and European Medicines Agency later approved 2 Hedgehog pathway inhibitors for the treatment of advanced basal cell carcinomas, vismodegib and sonidegib. Here, we present a review of the current English language literature trying to analyze differences in the 2 drugs as a head-to-head comparison between them has not already been documented in a randomized controlled clinical trial. Although vismodegib and sonidegib showed similar efficacy and safety profiles, in an indirect comparison scenario, sonidegib has shown slightly better outcomes in locally advanced basal cell carcinoma than vismodegib. They present different molecular structures, as they bind different residues on their targets and develop resistance for different mutations. In a future scenario, clinical trials comparing the 2 drugs are needed, as well as expanding data on discontinuation of therapy and/or consequential administration of them, with the aim to improve our clinical practise.

9.
PLoS One ; 15(8): e0237267, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32785291

RESUMO

BACKGROUND: Knowledge regarding differences in care for psoriatic patients is limited. The aim of this study was to investigate factors influencing prescription of systemic treatments for patients with psoriasis with a special focus on socioeconomic factors. METHODS AND FINDINGS: This was a non-interventional, cross-sectional study, conducted in 18 Italian University and/or hospital centers with psoriasis-specialized units. Questionnaires evaluating demographic and socioeconomic characteristics were administered to participants. Overall, 1880 consecutive patients affected by mild-to-severe psoriasis were recruited. Univariate and multivariable logistic regression analyses of systemic therapy prescription, with a special focus on biologics, accounting for the above mentioned characteristics were performed. Our analysis showed that all analyzed patients' characteristics were significantly associated with biological therapy compared to non-biological systemic one. Particularly, women were less likely to receive biologics than men (OR = 0.66; 95% CI, 0.57-0.77). Elderly patients (≥65 years) and subjects with a BMI ≥30 had lower odds to receive biologics respect to adults (≥35-64 years) (OR = 0.33; 95% CI, 0.25-0.40), and subjects with BMI≥25<30 (OR = 0.64; 95% CI, 0.53-0.77), respectively. Northern and Southern patients were both less likely to receive biologics than Central patients (OR = 0.75; 95% CI, 0.63-0.89, and OR = 0.56; 95% CI,0.47-0.68, respectively). Lower economic profile and never reading books were both associated with decreased odds of receiving biological therapy. CONCLUSIONS: This study shows that sex, age, comorbidities, and socioeconomic characteristics influence the prescription of systemic treatments in psoriasis, highlighting that there are still unmet needs influencing the therapeutic decision-making process that have to be addressed.

10.
Postgrad Med J ; 2020 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-32646970

RESUMO

Psoriasis (PsO) is a chronic skin disease. This study aims to evaluate clinical and subclinical response to calcipotriol+betamethasone foam, in patients with PsO, comparing, for the first time, data from microvascular ultrasound (MicroV) and shear wave elastography (SWE) with Psoriasis Area and Severity Index (PASI). METHODS: Between November 2018 and April 2019 in Tor Vergata Hospital (Roma, Italy), we enrolled 26 patients with PsO who were ageds 20-75 years, with PASI score ≥4, candidated for calcipotriol+betamethasone foam treatment. They underwent MicroV and SWE evaluation at baseline (T0) and after 4 weeks of treatment (T4). Clinical follow-up was carried on at T4, T8 and T12. Student's t-test (p values<0.05 statistically significant) was used to compare SWE and PASI values. RESULTS: At T0, SWE stiffness values of target plaques (61.5% on elbows, 23% knees, 7.7% sacrum,7.7% legs) were significantly higher than values under healthy skin. At T4, all patients showed a significant reduction of PASI; MicroV showed reduction in vascularisation of responsive plaques in 85% of cases, only in 15%, the vascularisation degree remained stable; and SWE values of target plaques were significantly lower compared with T0. Only in 7.7%, there was a relapse at T12. CONCLUSIONS: Calcipotriol+betamethasone foam is a very effective topical treatment in a short-medium term follow-up in patients with PsO. MicroV and SWE evaluate response to treatment (in term of plaque vascularisation and stiffness), so they could represent promising early indicators of therapeutic response and help the physician to establish a better clinical-therapeutic management of patients with PsO.

11.
J Cardiopulm Rehabil Prev ; 40(4): 205-208, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32609464

RESUMO

DETAILS OF THE CLINICAL CASE: A 51-yr-old man underwent a respiratory rehabilitation program (RRP), after being tracheostomized and ventilated due to acute respiratory distress syndrome (ARDS) from coronavirus disease-2019 (COVID-19) infection. Respiratory care, early mobilization, and neuromuscular electrical stimulation were started in the ad hoc isolation ward of our rehabilitation center. At baseline, muscle function was consistent with intensive care unit-acquired weakness and the patient still needed mechanical ventilation (MV) and oxygen support. During the first week of RRP in isolation, the patient was successfully weaned from MV, the tracheal cannula was removed, and the walking capacity was recovered. At the end of the RRP, continued in a standard department, respiratory muscles strength increased by 7% and muscle function improved as indicated by the quadriceps size enlargement of 13% and the change of the Medical Research Council sum score from 48/60 to 58/60. DISCUSSION: Providing RRP in patients with severe COVID-19 ARDS involves risks for operators and organizational difficulties, especially in rehabilitation centers; nevertheless, its continuity is important to prevent the development of permanent disabilities in previously healthy subjects. Limited to the experience of only one patient, we were able to carry out a safe RRP during the COVID-19 pandemic, promoting the complete functional recovery of a COVID-19 young patient. SUMMARY: Most patients who develop serious consequences of COVID-19 infection risk a reduction in their quality of life. However, by organizing and directing specialized resources, subacute rehabilitation facilities could ensure the continuity of the RRPs even during the COVID-19 pandemic.


Assuntos
Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Síndrome do Desconforto Respiratório do Adulto/reabilitação , Terapia Respiratória/métodos , Desmame do Respirador/métodos , Infecções por Coronavirus/diagnóstico , Estudos de Viabilidade , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Isolamento de Pacientes , Pneumonia Viral/diagnóstico , Recuperação de Função Fisiológica , Centros de Reabilitação , Respiração Artificial/métodos , Síndrome do Desconforto Respiratório do Adulto/virologia , Testes de Função Respiratória , Medição de Risco , Índice de Gravidade de Doença , Traqueostomia/métodos , Resultado do Tratamento
12.
Dermatol Ther ; : e14057, 2020 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-32713089

RESUMO

Basal cell carcinoma (BCC) is the most common skin cancer in humans. Pigmented basal cell carcinoma (pBCC) is a rare variant of BCC. Vismodegib, was the first drug to be approved for the treatment of locally advanced (laBCCs) or metastatic basal cell carcinoma. The aim of this study was to evaluate the efficacy of Vismodegib in patients with pBCCs. We retrospectively analyzed patients receiving Vismodegib as treatment for laBCCs presenting also various pBCCs. After 6 months of treatment, we performed excisional biopsies of pBCCs, that apparently at clinical and dermoscopic assessment did not respond to therapy. A total of nine patients were assessed. After 6 months of treatment, locally advanced target BCCs showed complete remission in four out of nine patients (44.4%), four patients (44.4%) were considered in partial remission and one patient (11%) showed no response to treatment. On the contrary, all the pBCCs showed both clinically and dermoscopically resistance to treatment. Therefore, clinically persistent pBCCs were surgically removed in three patients. Histology showed a complete elimination of the neoplastic cells together with features of previous regression. Our findings indicate that the efficacy of Vismodegib is higher than that documented by clinical or even dermatoscopic observation alone.

13.
Int J Mol Sci ; 21(14)2020 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-32664543

RESUMO

Recently, the world has been dealing with a devastating global pandemic coronavirus infection, with more than 12 million infected worldwide and over 300,000 deaths as of May 15th 2020, related to a novel coronavirus (2019-nCoV), characterized by a spherical morphology and identified through next-generation sequencing. Although the respiratory tract is the primary portal of entry of SARS-CoV-2, gastrointestinal involvement associated with nausea, vomiting and diarrhoea may also occur. No drug or vaccine has been approved due to the absence of evidence deriving from rigorous clinical trials. Increasing interest has been highlighted on the possible preventative role and adjunct treatment of lactoferrin, glycoprotein of human secretions part of a non-specific defensive system, known to play a crucial role against microbial and viral infections and exerting anti-inflammatory effects on different mucosal surfaces and able to regulate iron metabolism. In this review, analysing lactoferrin properties, we propose designing a clinical trial to evaluate and verify its effect using a dual combination treatment with local, solubilized intranasal spray formulation and oral administration. Lactoferrin could counteract the coronavirus infection and inflammation, acting either as natural barrier of both respiratory and intestinal mucosa or reverting the iron disorders related to the viral colonization.


Assuntos
Infecções por Coronavirus/prevenção & controle , Lactoferrina/uso terapêutico , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus/isolamento & purificação , Betacoronavirus/fisiologia , Infecções por Coronavirus/patologia , Infecções por Coronavirus/virologia , Humanos , Inflamação , Mucosa Intestinal/efeitos dos fármacos , Mucosa Intestinal/virologia , Ferro/metabolismo , Lactoferrina/farmacologia , Peptidil Dipeptidase A/metabolismo , Pneumonia Viral/patologia , Pneumonia Viral/virologia , Mucosa Respiratória/efeitos dos fármacos , Mucosa Respiratória/virologia , Internalização do Vírus/efeitos dos fármacos
14.
J Am Acad Dermatol ; 2020 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-32730850

RESUMO

BACKGROUND: There is lack of studies on the diagnostic accuracy of dermatoscopy and reflectance confocal microscopy (RCM) for dark pigmented lesions. OBJECTIVE: To assess the diagnostic accuracy of dermatoscopy plus confocal microscopy for melanoma diagnosis of dark pigmented lesions in real life. METHODS: Prospective analysis of difficult dark lesions with clinical-dermatoscopic suspicion of melanoma referred to RCM for further analysis. Outcome of lesions could be: excision or dermatoscopic digital follow up. RESULTS: We included 370 clinically dark lesions from 350 patients (median age, 45 years). Due to the clinical-dermatoscopic-RCM approach, we saved 129/213 unnecessary biopsies (specificity of 60.6%) with a sensitivity of 98.1% (154/157). Number needed to excise with the addition of RCM was 1.5 for melanoma diagnosis. LIMITATIONS: Single institution based; Italian population only. CONCLUSIONS: This study demonstrated that RCM coupled with dermatoscopy increase the specificity for diagnosing melanoma and it helps to correctly identify benign lesions. Our findings provide the basis for subsequent prospective studies on melanocytic neoplasms belonging to patients in different countries.

15.
Expert Opin Biol Ther ; : 1-2, 2020 Jun 16.
Artigo em Inglês | MEDLINE | ID: covidwho-574667

RESUMO

INTRODUCTION: In light of the current Covid-19 pandemic and the ongoing, extensive debate about the use of biological agents in psoriatic patients, we felt compelled to relate our experience in the use of secukinumab in the same cohort before and during the lockdown in Italy. Areas covered: Secukinumab was not discontinued, and there were no cases of confirmed infection with SARS-CoV-2 in this cohort. Expert opinion: In our practice, there is no evidence favoring the discontinuation of secukinumab in these patients. We also present a brief commentary on the use of biological agents in patients with moderate-to-severe plaque psoriasis.

17.
Expert Opin Biol Ther ; 20(8): 829-830, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32510244

RESUMO

INTRODUCTION: In light of the current Covid-19 pandemic and the ongoing, extensive debate about the use of biological agents in psoriatic patients, we felt compelled to relate our experience in the use of secukinumab in the same cohort before and during the lockdown in Italy. Areas covered: Secukinumab was not discontinued, and there were no cases of confirmed infection with SARS-CoV-2 in this cohort. Expert opinion: In our practice, there is no evidence favoring the discontinuation of secukinumab in these patients. We also present a brief commentary on the use of biological agents in patients with moderate-to-severe plaque psoriasis.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Betacoronavirus , Fatores Biológicos/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Psoríase/tratamento farmacológico , Índice de Gravidade de Doença , Idoso , Anticorpos Monoclonais Humanizados/farmacologia , Fatores Biológicos/farmacologia , Terapia Biológica/métodos , Estudos de Coortes , Infecções por Coronavirus/complicações , Infecções por Coronavirus/imunologia , Feminino , Humanos , Interleucina-17/antagonistas & inibidores , Interleucina-17/imunologia , Itália , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/imunologia , Psoríase/complicações , Psoríase/imunologia , Resultado do Tratamento
18.
Int J Dermatol ; 59(7): 813-821, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32406113

RESUMO

BACKGROUND: Nevus-associated melanoma (NAM) has been regarded as a distinct biological entity from de-novo melanoma (DNM); however, static dermoscopy often fails in differentiating these entities. Digital dermoscopic monitoring allows to identify dynamic changes occurring during follow-up; this may improve diagnostic accuracy and potentially our knowledge on NAM biology. We aimed to define main independent factors associated with NAM diagnosis and those influencing follow-up time in a population of melanomas excised at follow-up. METHODS: A cohort of melanomas excised at follow-up was retrospectively and consecutively selected. NAMs and DNMs were compared according to baseline features and main dermoscopic changes occurring during follow-up. Univariate and multivariable logistic and Cox's regression analysis were performed to respectively define factors associated with NAM diagnosis and those influencing the risk for excision. RESULTS: Eighty-six melanomas were enrolled, of which 21 (24.4%) were nevus-associated. During follow-up NAMs mainly underwent atypical network modifications (47.6%), followed by inverse network (28.6%) and dermoscopic island (23.8%) worsening or appearance. DNMs were also mainly characterized by atypical network modifications (47.7%), however, a significant proportion of cases underwent irregular pigmentation/dots/globules or regression changes (29.2%), which were rarely seen among NAMs. Furthermore, both multivariable logistic and Cox's regression analysis demonstrated a significant association between NAM and a longer follow-up. CONCLUSIONS: We demonstrated that among melanomas excised at follow-up, different patterns of dermoscopic changes may be found between NAMs and DNMs. This finding, together with the association of NAM with a longer follow-up time, supports the hypothesis of different biological behavior of these two entities.

20.
J Cosmet Dermatol ; 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32356917

RESUMO

BACKGROUND: Retinoids and alpha-hydroxy acids are commonly used topically as anti-aging substances. Current medical devices contain retinoic acid (0.02%) and glycolic acid (4%) in a polyvinyl gel vehicle (R-G gel). There are still no clinical data nor objective evaluation of the anti-aging effect this product has in the short term. AIMS: To assess in a prospective 1-month, noncomparative, primary outcome assessor-blinded proof-of-concept trial the clinical efficacy, tolerability, and the skin cells modification (evaluated through reflectance confocal microscopy; RCM), of R-G gel in skin aging treatment. METHODS: Twelve women with moderate-severe skin aging (Glogau score ≥ 3) were enrolled. The product was applied on the face three times a week for 4 weeks. Study visits were performed at baseline and after 2 and 4 weeks. RCM evaluation was performed openly at each visit using Viva Scope 1500 to evaluate the left cheek (5 mm below the zygomatic process). RESULTS: Eleven subjects concluded the trial. At baseline, the Glogau score was 3.4 ± 0.5 and decreased significantly at week 4 (P = .0001; ANOVA test) to 2.7 ± 0.6. Significant reductions of dark spots (-40%) and severity of wrinkles (-12%) were observed at week 4 compared to baseline. The RCM score improved significantly at week 4 with the recovery of the polygonal keratinocytes pattern as the central aspect observed. CONCLUSION: The gel containing retinoic acid and glycolic acid showed significant improvements of the clinical signs of severe skin aging with a concomitant improvement of epidermal and dermal structures evaluated via RCM.

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