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1.
Artigo em Inglês | MEDLINE | ID: mdl-38284131

RESUMO

BACKGROUND: There is limited epidemiological evidence on outcomes associated with dupilumab exposure during pregnancy; monitoring pregnancy outcomes in large populations is required. OBJECTIVE: To investigate the potential association between exposure to dupilumab in pregnant women with atopic dermatitis and any adverse pregnancy, neonatal, congenital and post-partum outcomes. METHODS: We performed a multicentre retrospective cohort study across 19 Italian tertiary referral hospital. Childbearing women were eligible if aged 18-49 years and carried out the pregnancy between 1 October 2018 and 1 September 2022. RESULTS: We retrospectively screened records of 5062 patients receiving dupilumab regardless of age and gender, identifying 951 female atopic dermatitis patients of childbearing age, 29 of whom had been exposed to the drug during pregnancy (3%). The median duration of dupilumab treatment prior to conception was 22.5 weeks (range: 3-118). The median time of exposure to the drug during pregnancy was 6 weeks (range: 2-24). All the documented pregnancies were unplanned, and the drug was discontinued in all cases once pregnancy status was reported. The comparison of the study cohort and the control group found no significant drug-associated risk for adverse pregnancy, congenital, neonatal or post-partum outcomes. The absence of a statistically significant effect of exposure on the event was confirmed by bivariate analysis and multivariate analysis adjusted for other confounding factors. CONCLUSIONS: This cohort of pregnant patients exposed to dupilumab adds to the existing evidence concerning the safety of biologic agents in pregnancy. No safety issues were identified regarding the primary outcome assessed. In clinical practice, these data provide reassurance in case of dupilumab exposure during the first trimester. However, the continuous use of dupilumab throughout pregnancy warrants further research.

4.
J Clin Med ; 12(8)2023 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-37109106

RESUMO

INTRODUCTION: Patients undergoing a total thyroidectomy for multinodular goiter typically have a long clinical history of the disease. They often come to surgery for compression symptoms, with no suspicion of neoplastic disease. For these patients, the incidence of microcarcinomas is high, even though we know that this does not affect subsequent therapies and long-term survival. On the other hand, when a true incidental carcinoma is present, the patient requires specific therapy and long-term follow-up. The purpose of the study was to identify the incidence of incidental carcinomas in the high prevalence region of goiter, the clinical-pathological characteristics of the tumor, and the therapeutic implications. METHOD: This is a retrospective study, from January 2010 to December 2020, on a case series of 1435 total thyroidectomies for goiters. All patients had a preoperative diagnosis of a benign disease. Gender, mean age, and mean duration from the initial diagnosis of goiter were evaluated along with the number and frequency of fine needle aspirations carried out. On the basis of the histological examination, the incidence of incidental carcinoma was then assessed (diameter ≥ 10 mm) as well as the incidence of microcarcinoma (diameter < 10 mm), the pathological characteristics (multifocality, capsular invasion), and the subsequent prescribed therapies. RESULTS: Patients with incidental carcinoma numbered 41 (2.8%%), 34 women and 7 men. The mean age was 53.5 years, while the patients diagnosed with microcarcinoma were 88 (6.1%). The mean duration of the disease from initial diagnosis was 7.8 years. On average, these patients underwent 1.8 fine needle aspirations during the course of the disease, almost exclusively in the first four years. The mean diameter of the tumor was 1.35 cm (±0.3). Multifocality was present in six patients, while only one patient presented capsular invasion. The chi-square test delivered a significant dependence on gender in terms of the incidental diagnosis after Yates correction (chi-stat = 5.064; p = 0.024), highlighting a higher incidence in the female population. All patients underwent subsequent metabolic radiotherapy. The mean follow-up was 6.3 years and in the 35 patients examined, none displayed any recurrence of the disease. CONCLUSIONS: Incidental carcinoma is not uncommon in patients who have undergone total thyroidectomy for goiters. It must be differentiated from microcarcinoma for its therapeutic implications and the follow-up of the patient. Statistical analysis has shown that the only significant variable is gender. In a goiter area, the careful monitoring of patients is required to highlight suspicious clinical-instrumental aspects that may appear even several years after the initial diagnosis.

5.
Australas J Dermatol ; 64(2): 285-288, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-36779423

RESUMO

Down syndrome (DS) is the most common chromosomal disorder; several dermatological conditions are common in these patients; among them, psoriasis and atopic dermatitis can be frequently encountered. From 2017 to today, we retrospectively identified 4 adults and 3 under 18-year-old patients treated with biological drugs, from our research database. The first endpoint of this study was to evaluate whether the biological drugs work in these special population, and a secondary endpoint was to evaluate any loss of efficacy or any side effects during follow-up. All patients were treated with biological drugs experience resolution of their psoriasis. Mean PASI (Psoriasis Area Severity Index), BSA (Body Surface Area) and DLQI (Dermatology Life Quality Index) at baseline were 20, 16.5 and 25. At week 4, mean PASI, BSA and DLQI decreased, respectively, to 8, 6 and 12, while at week 24, mean values were, respectively, 3, 1.3 and 1. The patients that started therapy earlier, at week 52, do not have signs of recurrence and side effects. We highlighted that no official guidelines exist to approach these patients, from a literature evaluation the most employed drugs are anti-TNFα and in particular adalimumab. In our experience, the new anti-interleukin drugs seem to be well-tolerated, with no sides effect, good compliance and no loss of efficacy.


Assuntos
Produtos Biológicos , Dermatologia , Síndrome de Down , Psoríase , Adulto , Humanos , Adolescente , Síndrome de Down/complicações , Síndrome de Down/tratamento farmacológico , Estudos Retrospectivos , Qualidade de Vida , Índice de Gravidade de Doença , Psoríase/tratamento farmacológico , Produtos Biológicos/uso terapêutico , Resultado do Tratamento
12.
Ann Ital Chir ; 93: 224-228, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35478187

RESUMO

Hepatic cysts have become increasingly frequent findings thanks to the improvement in diagnostic investigations. Distinction has to be made between congenital hepatic cysts (like liver cyst, PLCD) and acquired forms (such as a parasitic cyst and a cyst occurring as part of a neoplastic process) (1). When a simple hepatic cyst becomes symptomatic, when its size is > 4 cm or when there is some radiological suspicion of malignancy (thick wall, peripheral enhancement on CT/MRI) surgical management is indicated and relies on a variety of techniques (2). Presently the two most common techniques are percutaneous aspiration with sclerotherapy and laparoscopic fenestration. The use of laparoscopic approach has achieved, in the last years, some great results, for it shortens hospital stay, involves minimal invasiveness and offers low recurrence rate. We report three cases of symptomatic hepatic cysts successfully treated by using laparoscopic procedure. KEY WORDS: Laparoscopic deroofing, Sclerotherapy, Simple hepatic cysts.


Assuntos
Cistos , Laparoscopia , Hepatopatias , Cistos/cirurgia , Humanos , Laparoscopia/métodos , Hepatopatias/diagnóstico , Hepatopatias/cirurgia , Escleroterapia/métodos
13.
J Clin Aesthet Dermatol ; 15(2): 23-25, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35309878

RESUMO

Background: Recently it has been reported that apremilast might promote melanogenesis and it would therefore not be safe to use this drug in patients with psoriasis who have a history of melanoma. Methods: From January 2017 to December 2020, we retrospectively identified, within a cohort of 635 patients in follow-up care for melanoma, 16 cases of patients with psoriasis treated with apremilast and history of melanoma. Patients were monitored at our unit for a mean duration of 36 months of follow up. Results: The use of apremilast, in our case series was, thus, effective in managing psoriasis without causing recurrence of previous melanoma or any new suspicious lesions which would need removal. Discussion: It has been speculated that apremilast might not be safe in patients who have a history of melanoma as it would be involved in the stimulation of melanogenesis and consequent possibility of recurrence of previous melanoma. Conclusion: Our data show that none of the patients treated with apremilast developed recurrence of melanoma at 36 months of follow-up. Further studies are necessary to confirm the safety of apremilast in a larger number of patients with concurrent malignancies, specifically melanoma, and for a longer follow-up period.

14.
Dermatol Pract Concept ; 12(1): e2022155, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35223191

RESUMO

Atopic dermatitis is a Th2 disease, due to relapse of IL-4 and IL-13 by Th2 cells. Despite the approval by FDA of dupilumab, the first monoclonal antibody for the severe forms, traditional drugs remain a milestone for the treatment of this dermatosis. Dermatologists need a good knowledge of all therapies for an integrated and personalized management of patients.

16.
Eur Psychiatry ; 64(1): e71, 2021 11 25.
Artigo em Inglês | MEDLINE | ID: mdl-34819201

RESUMO

BACKGROUND: Mental disorders in comorbidity with chronic skin diseases may worsen disease outcome and patients' quality of life. We hypothesized the comorbidity of depression, anxiety syndromes, or symptoms as attributable to biological mechanisms that the combined diseases share. METHODS: We conducted a systematic review based on the Preferred Reporting Items for Systematic Review and Meta-Analysis statement searching into PubMed, PsycInfo, and Scopus databases. We examined the literature regarding the comorbidity of psoriasis (Ps), atopic dermatitis (AD), or hidradenitis suppurativa with depression and/or anxiety in adults ≥18 years and the hypothetical shared underlying biological mechanisms. RESULTS: Sixteen studies were analyzed, mostly regarding Ps and AD. Brain-derived neurotrophic factor/tropomyosin receptor kinase B signaling and nuclear factor kappa-light-chain-enhancer of activated B cells/p38 mitogen-activated protein kinase pathways arose as shared mechanisms in Ps animal models with depression- and/or anxiety-like behaviors. Activated microglia and neuroinflammatory responses emerged in AD depressive models. As to genetic studies, atopic-dermatitis patients with comorbid anxiety traits carried the short variant of serotonin transporter and a polymorphism of the human translocator protein gene. A GA genotype of catechol-O-methyltransferase gene was instead associated with Ps. Reduced natural killer cell activity, IL-4, serotonin serum levels, and increased plasma cortisol and IgE levels were hypothesized in comorbid depressive AD patients. In Ps patients with comorbid depression, high serum concentrations of IL-6 and IL-18, as well as IL-17A, were presumed to act as shared inflammatory mechanisms. CONCLUSIONS: Further studies should investigate mental disorders and chronic skin diseases concurrently across patients' life course and identify their temporal relation and biological correlates. Future research should also identify biological characteristics of individuals at high risk of the comorbid disorders and associated complications.


Assuntos
Dermatite Atópica , Hidradenite Supurativa , Psoríase , Animais , Ansiedade , Catecol O-Metiltransferase , Comorbidade , Depressão/epidemiologia , Dermatite Atópica/epidemiologia , Hidradenite Supurativa/epidemiologia , Humanos , Psoríase/epidemiologia , Qualidade de Vida
20.
Int J Dermatol ; 60(11): 1405-1410, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33998695

RESUMO

BACKGROUND: It is well known that the number of nevi varies with age. However, there are a few data in the literature concerning total nevus count at different ages. The aim of this study was to assess and compare the total nevus count among different age groups. METHODS: The total nevus count was assessed in consecutive patients belonging to nine age groups. Median nevus count was calculated and compared for each age group. Multivariate logistic regression analysis was used to define the influence of sex and phototype on the association between nevus count and age. RESULTS: We enrolled 900 patients (461, 51.2% females), with a median age of 46 years and a total of 18,136 nevi. Significant differences were found in the median total nevus count among all age groups (P < 0.001), with a significant increase in the first two decades and a significant decrease after the age of 50 years. A similar trend was also observed in subgroups. The differences observed in the total body nevus count among age groups were independent of sex and phototype. CONCLUSIONS: We demonstrate that the total nevus count significantly increases during childhood and gradually decreases in the elderly.


Assuntos
Nevo Pigmentado , Nevo , Neoplasias Cutâneas , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nevo Pigmentado/epidemiologia , Fatores de Risco , Neoplasias Cutâneas/epidemiologia
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