Association between maternal dupilumab exposure and pregnancy outcomes in patients with moderate-to-severe atopic dermatitis: A nationwide retrospective cohort study.

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.

Monkeypox outbreak in Genoa, Italy: Clinical, laboratory, histopathologic features, management, and outcome of the infected patients.

Since May 2022, multiple human Monkeypox cases were identified in nonendemic countries, mainly among men who have sex with men. We aimed to report the features, clinical course, management, and outcome of the Monkeypox cases diagnosed in the Dermatology and Infectious Disease Units of the San Martino Hospital, Genoa, Italy. We performed an observational study of the Monkeypox cases diagnosed from July 1 until August 31, 2022, collecting clinical, laboratory, and histological data. We studied 16 Monkeypox-infected men (14 homosexual, 2 bisexual) with a median age of 37 years. Three were HIV-infected. All patients reported multiple sexual partners and/or unprotected sex in the 2 weeks before the diagnosis. Most patients had prodromal signs/symptoms before the appearance of the skin/mucosal eruption, consisting of erythematous papules/vesicles/pustules in the anogenital area, which tended to erode evolving into crusts and ulcers. Lesions were often associated with local and/or systemic symptoms. Histopathology showed overlapping features in all cases: epidermal ulceration and dermal inflammatory infiltrate consisting of lymphocytes and neutrophils with an interstitial and perivascular/peri-adnexal pattern and endothelial swelling. Concomitant sexually transmitted infections (STIs) (gonococcal/nongonococcal proctitis and anal high-risk human papillomavirus [HR-HPV] infection) were frequent. Four patients were hospitalized, and one received specific treatment. The overall outcome was good. At the follow-up visit, three patients presented skin scars. Our series confirms the features of the current Monkeypox outbreak; however, different from other studies, we found a considerable rate of concomitant STIs, such as anal HR-HPV infection, that should be kept in mind because this persistent infection is the main cause of anal cancers.

Knowledge and attitudes regarding sexually transmitted infections among healthcare workers.

BACKGROUND: Healthcare workers have a fundamental role in providing care and education on sexually transmitted infections (STIs). However, their knowledge is often worryingly limited. This study aimed to assess the real knowledge and attitude regarding STIs among healthcare workers of the IRCCS Ospedale Policlinico San Martino, Genoa, Italy. METHODS: The recruited subjects were asked to complete a 31-item questionnaire, divided into 3 sections: socio-demographic context, knowledge about STIs, and personal sexual behavior. RESULTS: We enrolled 140 subjects, employed as nurses (52.9%), physicians (12.9%), laboratory technicians (7.1%), or other workers (27.1%). Despite the generalized erroneous belief of having a good level of knowledge on the matter, only one-third of the subjects could correctly identify STIs among a list of diseases, and less than one-third correctly recognize all possible ways of transmission. Human immunodeficiency virus (HIV) was the most frequently recognized STI (97%), but only 39.2% of healthcare workers were correctly informed about the body fluids that can transmit the virus. Most participants (93.5%) correctly identified condoms as effective in preventing STIs but did not indicate complete abstinence as the only way to guarantee protection against STIs. Most participants were informed on the oncogenic potential of human papillomavirus (HPV) infections (82%), the usefulness of the Pap test (85.7%), and the existence of vaccines against some STIs (63.5%). CONCLUSIONS: Overall, healthcare workers have limited knowledge about STIs. Creating specific educational programs aimed at healthcare providers should become a priority.

Prevalence of cutaneous manifestations and myositis-specific antibodies in COVID-19 patients and Anti-PL7 antibodies association with pulmonary radiological severity: A retrospective study.

BACKGROUND: Dermatomyositis (DM) is an idiopathic immune-mediated myopathy, and may involve many organs, including muscles, skin and lungs. Myositis-specific autoantibodies (MSAs) are a useful aid in diagnosis DM and identifying its clinical subtype. During the COVID-19 pandemic, several studies found clinical similarities regarding lung involvement in both COVID-19 and DM. Such similarities have prompted speculation of a common pathogenetic mechanism. Indeed, viral infections are well-known triggers of autoimmune diseases. This prompted us to investigate whether circulating MSAs could be markers of the severity of lung involvement and of clinical outcome in COVID-19 patients. Moreover, we investigated the presence of cutaneous signs of DM in COVID-19 patients. METHODS: We conducted a retrospective cohort study on 178 hospitalized patients affected by COVID-19. The diagnosis was confirmed by naso-pharyngeal swab positivity for SARS-CoV-2. The severity of lung involvement was assessed by assigning to each patient a radiological score ranging from 1 to 4, based on chest imaging (chest X-rays or CT scans). Serum samples were tested for MSAs. RESULTS: Anti-PL-7 antibodies were detected in 10.1% of patients and were found to be associated with an increased risk of severe pulmonary involvement (p = 0.019) and a worse prognosis in COVID-19 patients. Cutaneous lesions were observed in 26.4% of patients. However, none were cutaneous manifestations of DM. CONCLUSIONS: The detection of anti-PL7 antibodies might predict severe pulmonary involvement and a worse prognosis in COVID-19 patients.

Diffuse Melanosis Cutis as the First Sign of Recurrence of Low-Risk Melanoma: Case Report and Systematic Review.

INTRODUCTION: Diffuse Melanosis Cutis (DMC) is a rare and late complication of metastatic malignant melanoma (MM) characterized by progressive pigmentation of skin and sometimes mucous membranes. The distinctive feature is the widespread and progressive deposition of melanin precursors in the dermis. OBJECTIVES: The purpose of this review is to define the clinical and demographic features of DMC and to promote a deeper insight into the clinical manifestation, histological findings, and pathophysiology behind DMC. METHODS: We have conducted a systematic review of the literature on published DMC in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. We also reported a case of DMC secondary to low-risk melanoma. RESULTS: Overall, including our case report, we reported 53 articles described 62 DMC patients. Breslow level of primary melanoma was reported having a mean value of 3.3 mm. The mean survival rate from onset of DMC resulted being 4.36 months. CONCLUSIONS: Among the most widely accepted etiopathogenetic hypotheses are deposition of melanic precursors in the dermis following tumor lysis, melanocyte proliferation induced by neoplastic growth factors, and the presence of diffuse dermal micro-metastases of MM. However, unanimous consensus on the proposed etiopathogenetic models of DMC is still lacking.

Increased serum level of N-terminal Pro-B-type natriuretic peptide in psoriatic patients: a single-center study.

BACKGROUND: Psoriasis is associated with multiple comorbidities, including cardiovascular disease. Identifying biomarkers such as N-terminal fragment of the BNP precursor (NT-pro-BNP) with preventive, diagnostic, and prognostic implications in the cardiovascular diseases of psoriatic patients may be helpful in these patient's management. However, their predictive ability for future cardiovascular events in psoriatic patients is still unknown. Therefore, the study aimed to determine whether NT-pro-BNP levels were increased in psoriatic patients. METHODS: One hundred forty psoriatic patients without cardiovascular disease and 140 healthy control patients were enrolled. RESULTS: The NT-pro-BNP level was significantly correlated with lipid profile but not with disease duration; or the ongoing biologic therapy. CONCLUSIONS: Our work demonstrates that pro-BNP values are higher in patients with psoriasis than in controls and emphasizes the correlation between psoriasis and cardiovascular disease and the importance of biomarkers that can identify those patients most at risk of developing cardiovascular disease.

Sexually transmitted infections in male prison inmates. Prevalence, level of knowledge and risky behaviours.

Data on the prevalence of sexually transmitted infections (STIs) and risk factors among incarcerated people are few and data about STIs awareness among inmates are even lacking. This study aimed to assess prevalence of STIs, risky behaviours and STIs level of knowledge in male inmates of the Casa Circondariale-Genova Marassi, the main penitentiary in Genoa, Italy. Between January and June 2019, 662 inmate medical records were retrospectively examined to obtain clinical and laboratory data about STIs. To investigate the inmate level of knowledge of STIs and their risky behaviours, 111consenting participants answered, anonymously, a written questionnaire. One hundred and twenty-two patients had at least one infectious disease when entered the prison: HIV (1.8%), HBV (2.7%), HCV (12.5%) and syphilis (1.3%). When asked to select from a list of diseases which ones they thought to be sexually transmitted, only 12% of the inmates answered correctly; most of them ignored which body fluids are at risk for HIV transmission, which STIs can induce tumors and if any vaccination exists to prevent STIs. Substance abuse was common among inmates that frequently exchanged needles for injecting drugs. To reduce the STIs incidence, it is necessary to target high-risk populations: everyone entering a prison should be offered a systematic screening of all STIs, including those currently neglected. Since STIs knowledge among inmates is poor and risky behaviours are diffuse, informative interventions in prison may provide an opportunity to educate such a high-risk population.