Search

Purpose Anorexia nervosa (AN) is a serious and complex mental disorder affecting mainly young adult women. AN patients are characterized by low body weight in combination with self-induced starvation, intense fear of gaining weight, and distortion of body image. AN is a multifactorial disease, linked by recent evidence to a dysregulation of the immune system. Methods In this pilot study, 22 blood serums from AN patients were tested for the presence of autoantibodies against primate hypothalamic periventricular neurons by immunofluorescence and by a home-made ELISA assay. Cellular fluorescence suggests the presence of autoantibodies which are able to recognize these neurons (both to body cell and fiber levels). By means of ELISA, these autoantibodies are quantitatively evaluated. In addition, orexigenic and anorexigenic molecules were measured by ELISA. As control, 18 blood serums from healthy age matched woman were analysed. Results All AN patients showed a reactivity against hypothalamic neurons both by immunofluorescence and ELISA. In addition, ghrelin, pro-opiomelanocortin (POMC), and agouti-related peptide (AGRP) were significantly higher than in control serums (p p Conclusions Immunoreaction and ELISA assays on AN blood serum suggest the presence of autoantibodies AN related. However, it is not easy to determine the action of these antibodies in vivo: they could interact with specific ligands expressed by hypothalamic cells preventing their physiological role, however, it is also possible that they could induce an aspecific stimulation in the target cells leading to an increased secretion of anorexigenic molecules. Further studies are needed to fully understand the involvement of the immune system in AN pathogenesis. Level of evidence V, descriptive study.

SommarioLa prima osservazione che la malnutrizione e la perdita di peso contribuiscano alla morte dei malati di cancro in maniera significativa e indipendentemente dagli effetti del tumore stesso risale a più di 70 anni fa. Da allora l’intervento nutrizionale, inteso sia come screening sia come trattamento medico orientato alla ricerca e alla cura della malnutrizione, ha assunto sempre più significato nella gestione della patologia tumorale. Ciò sia al suo esordio sia durante la naturale evoluzione della malattia, anche quando accompagnata dai trattamenti medici convenzionali (radioterapia, chemioterapia, chirurgia e cure palliative). La nutrizione artificiale nelle sue diverse declinazioni (supplementi nutrizionali orali, nutrizione enterale e parenterale), la farmacoterapia, il protocollo enhanced recovery after surgery (ERAS) e l’immunonutrizione sono ad oggi gli strumenti a nostra disposizione per invertire o almeno arrestare il processo prima che sopraggiunga la cachessia. Questa breve rassegna nasce con l’intento di descrivere a che punto siamo nel trattamento nutrizionale del paziente oncologico e quali sono ad oggi le evidenze di efficacia dei vari interventi nei diversi momenti di malattia.

A eucaloric very low carbohydrate diet (EVLCD) is a diet with a daily caloric intake equal to the total daily energy expenditure (TDEE) with a carbohydrate content of

Background: Some patients affected by COVID-19 present a life-threatening hyperinflammatory state known as cytokine storm syndrome (CSS) associated with a high mortality rate. Our hypothesis is that a eucaloric ketogenic diet (EKD) may be a safe and efficacious treatment option to reduce CSS and consequently to reduce the need for CPAP, ICU admission and COVID-19 mortality.Aim of the study: The primary objective is to explore the effect of an EKD on mortality, admission to the ICU and the need for NIV in hospitalized patients with COVID-19 in comparison to a eucaloric standard diet (ESD). The secondary objectives are to collect data about the safety and feasibility of an EKD during hospitalization and to evaluate the effect of the diet on biological and inflammatory parameters, particularly interleukin-6 (IL-6).Patients and methods: The study is a retrospective explorative analysis of 34 patients fed with an EKD during hospitalization for COVID-19 in comparison to 68 patients fed an ESD selected and matched using propensity score one-to-two to avoid the confounding effect of interfering variables.Results: A trend of reduced 30-day mortality (HR 0.416, 95% CI 0.122 – 1.413, P = 0.160) and a trend regarding the need for ICU admission (HR 0.357, 95% CI 0.045 – 2.847, P = 0.331) were observed in subjects treated with the EKD compared to patients fed with the standard diet. No significantly different risks in the need for CPAP (HR 0.968, CI 0.289 – 3.242, P = 0.958 for EKD) or the composite endpoint (HR 0.674, CI 0.233 – 1.949, P = 0.446 for EKD) were detectable between the two groups of dietary patterns.Furthermore, IL-6 concentrations between t 0 and t 7 (seven days after the beginning of the diet) in the ketogenic nutrition group showed a median difference of -26.0 ȵg/mL and a mean difference of -164 ȵg/mL (data from 23 of the 34 pairs) compared to controls, with a trend toward significance (P = 0.062). EKD was safe and no adverse events were observed in patients fed an EKD.Discussion and conclusions: These preliminary data on the clinical results for mortality, need for ICU admission and the effect on the IL-6 concentration during EKD feeding, collected in a retrospective way during the most aggressive period of the COVID-19 pandemic, suggest a favorable role of this dietary treatment in COVID-19 clinical management. The EKD was safe and well accepted by patients during hospitalization and seems to be an interesting tool in controlling COVID-19 CSS. The results of the prospective controlled randomized trial, currently underway with a large number of subjects, are necessary to confirm these preliminary data.

Background: Some patients affected by Covid 19 present a life threatening hyperinflammatory state known as a cytokine storm syndrome (CSS) associated with a high mortality rate. Our hypothesis is that eucaloric ketogenic diet (EKD) may be a safe and efficacious treatment option to reduce CSS and consequently to reduce need of CPAP, ICU admission and mortality COVID-19 related.Aim of the study: Primary objective is to explore the effect of EKD on mortality, access to ICU and the need of NIV in COVID-19 hospitalized patients in comparison to a eucaloric standard dietstandard diet (ESDESD). Secondary objectives are to collect data about safety and feasibility of EKD during hospitalization and to evaluate the effect of the diet on biological and inflammatory parameters and particularly on interleukin -6 (IL-6).Patients and Methods: The study is a retrospective explorative analysis of 34 patients fed with EKD during hospitalization for COVID-19 in comparison to 68 patients in ESDESD selected and matched using propensity score one-to-two to avoid the confounding effect of interfering variables.Results: A trend of reduction of 30-day mortality (HR 0.416, 95% CI 0.122 – 1.413, P = 0.160) and a trend in need for ICU admission (HR 0.357, 95% CI 0.045 – 2.847, P = 0.331) were observed in subjects treated with EKD respect to patients fed with standard one. No significant different risks in need for CPAP (HR 0.968, CI 0.289 – 3.242, P = 0.958 for EKD) and composite endpoint (HR 0.674, CI 0.233 – 1.949, P = 0.446 for EKD) were detectable between the two groups of dietary patterns.Furthermore, IL-6 concentrations, between t 0 and t 7 (seven days after the beginning of the diet), collected in the ketogenic nutrition group, show a median IL-6 difference of -26.0 ȵg/mL or a mean IL-6 difference of -164 ȵg/mL (data from 23 of the 34 pairs) compared to controls, with a trend to (P = 0.062).Discussion and conclusions: These preliminar data, collected in a retrospective way during the most aggressive period of Covid-19 pandemia, on clinical results on mortality, need for ICU and effect on IL-6 concentration during EKD suggest a favorable role of this dietary treatment in COVID-19 clinical management. EKD resulted well accepted by patients during hospitalization and seems to be an interesting tool in controlling Covid-19-CSS. The results of the prospective controlled randomized trial, actually ongoing, in a largest number of subjects are necessary to confirm these preliminary data.

Objectives To describe clinical characteristics, management and outcome of COVID-19 patients; and to evaluate risk factors for all-cause in-hospital mortality. Methods This retrospective study from a University tertiary care hospital in northern Italy, included hospitalized adult patients with a diagnosis of COVID-19 between February 25th, 2020 and March 25th, 2020. Results Overall, 317 patients were enrolled. Their median age 71 years and 67.2% were males (213/317). The most common underlying diseases were hypertension (149/317; 47.0%), cardiovascular disease (63/317, 19.9%) and diabetes (49/317; 15.5%). Common symptoms at the time of COVID-19 diagnosis included fever (285/317; 89.9%), shortness of breath (167/317; 52.7%) and dry cough (156/317,49.2%). An “atypical” presentation including at least one among mental confusion, diarrhea or nausea and vomiting was observed in 53/317 patients (16.7%). Hypokalemia occurred in 25.8% (78/302) and 18.5% (56/303) had acute kidney injury. During hospitalization, 111/317 patients (35.0%) received non-invasive respiratory support, 65/317 (20.5%) were admitted to the intensive care unit (ICU) and 60/317 (18.5%) required invasive mechanical ventilation. All cause in-hospital mortality, assessed in 275 patients, was 43.6% (120/275). On multivariable analysis, age (per-year increase odds ratio [OR]:1.07; 95% confidence interval [CI] 1.04-1.10, p

OBJECTIVES: Our primary objective was to explore the effect of a eucaloric ketogenic diet (EKD) on mortality, admission to the intensive care unit, and need for non-invasive ventilation in hospitalized patients with COronaVIrus Disease 19 (COVID-19), in comparison to a eucaloric standard diet. Secondary objectives were verification of the safety and feasibility of the diet and its effects on inflammatory parameters, particularly interleukin-6. METHODS: The study is a retrospective analysis of 34 patients fed with an EKD in comparison to 68 patients fed with a eucaloric standard diet, selected and matched using propensity scores 1:2 to avoid the confounding effect of interfering variables. Our hypothesis was that an EKD would reduce mortality, admission to the intensive care unit, and need for non-invasive ventilation in patients with COVID-19. RESULTS: The preliminary multivariate analysis showed a statistically significant difference in survival (P = 0.046) and need for the intensive care unit (P = 0.049) for the EKD compared with a eucaloric standard diet. Even considering the EKD start day as a time-dependent variable, the results maintain a positive trend for application of the diet, and it is not possible to reject the null hypothesis (P < 0.05). Interleukin-6 concentrations between t0 and t7 (7 d after the beginning of the diet) in the ketogenic nutrition group show a trend that is almost significant (P = 0.062). The EKD was safe and no adverse events were observed. CONCLUSIONS: These results show a possible therapeutic role of an EKD in the clinical management of COVID-19. Currently, a prospective controlled randomized trial is running to confirm these preliminary data.

Nicotinamide is the precursor of nicotinamide adenine dinucleotide (NAD+), an essential cofactor for adenosine triphosphate (ATP) production. It has recently been reported to be effective in reducing the rates of new non-melanoma skin cancers (NMSCs) and actinic keratosis (AKs). We studied the efficacy of oral nicotinamide as treatment for AKs in transplant recipients. We recruited 38 transplant (eight liver and 30 kidney) patients with single or multiple AKs. Nineteen patients were randomly assigned to Group 1 and took nicotinamide 500 mg/daily (cases); the other 19 patients were randomly assigned to Group 2 without nicotinamide (controls). At base-line, AKs were identified, measured, and photographed for follow-up. Five patients underwent an AK biopsy for histopathology. Statistical analyses were performed using the Student t test. At baseline, no statistically significant differences were observed regarding AK size between the two groups. After six months, among the cases, AKs had significantly decreased in size in 18/19 patients (88%). Among these 18 patients, seven patients (42%) had shown complete clinical regression and no patient developed new AKs. Conversely, among the controls, 91% showed an increase in AK size and/or developed new AKs. Seven pre-existing AKs progressed to squamous-cell carcinoma. Nicotinamide appears to be effective in preventing and treating AKs, although the mechanisms are still unclear. Further studies with a larger sample of organ transplant recipients and a longer follow-up period are needed to further support our conclusions.

Objectives To describe clinical characteristics, management and outcome of individuals with coronavirus disease 2019 (COVID-19); and to evaluate risk factors for all-cause in-hospital mortality. Methods This retrospective study from a University tertiary care hospital in northern Italy, included hospitalized adult patients with a diagnosis of COVID-19 between 25 February 2020 and 25 March 2020. Results Overall, 317 individuals were enrolled. Their median age was 71 years and 67.2% were male (213/317). The most common underlying diseases were hypertension (149/317; 47.0%), cardiovascular disease (63/317; 19.9%) and diabetes (49/317; 15.5%). Common symptoms at the time of COVID-19 diagnosis included fever (285/317; 89.9%), shortness of breath (167/317; 52.7%) and dry cough (156/317; 49.2%). An ‘atypical' presentation including at least one among mental confusion, diarrhoea or nausea and vomiting was observed in 53/317 patients (16.7%). Hypokalaemia occurred in 25.8% (78/302) and 18.5% (56/303) had acute kidney injury. During hospitalization, 111/317 patients (35.0%) received non-invasive respiratory support, 65/317 (20.5%) were admitted to the intensive care unit (ICU) and 60/317 (18.5%) required invasive mechanical ventilation. All-cause in-hospital mortality, assessed in 275 patients, was 43.6% (120/275). On multivariable analysis, age (per-year increase OR 1.07; 95% CI 1.04–1.10; p Conclusions COVID-19 mainly affected elderly patients with predisposing conditions and caused severe illness, frequently requiring non-invasive respiratory support or ICU admission. Despite supportive care, COVID-19 remains associated with a substantial risk of all-cause in-hospital mortality.

An exanthem is a skin rash that may be associated with mucous membrane eruption, fever or other symptoms. It may develop as manifestation of an infectious disease or as adverse reaction to drugs. Beside the ‘classical exanthems’ commonly occurring in childhood, other exanthems, defined as ‘atypical’ for the different morphology and causal agents, may occur. Among the atypical exanthems with infectious etiology, viral, bacterial, parasitic and helminth infections are implicated. We describe herein etiology and epidemiology of the atypical exanthems caused by infectious agents. In case of exanthem, to make a correct etiological diagnosis is crucial for both the patient and community concerning issues such as time off school, immunizations and risk in pregnancy and immunocompromised individuals.

A 33-year-old man presented with a two-week history of an asymptomatic ulcer of the oropharynx and submandibular lymph nodes swelling. Laboratory examinations were normal, but serological tests revealed positivity for rapid plasma reagin, Treponema pallidum haemagglutination assay and anti- T. pallidum IgM antibodies. Since the patient denied any homosexual relationship, a biopsy of the lesion was performed, which confirmed primary syphilis. The patient received an intramuscular injection of Benzathine Penicillin G (2.4 MU) with complete resolution of the lesion. Extragenital chancres occur in at least 5% of patients with primary syphilis, and the oral mucosa is the most frequent location as a consequence of orogenital/oroanal contact with an infectious lesion. Because of their transient nature, these oral ulcerations are often underestimated by the patient or by any unsuspecting clinician. Health professionals should consider the recent sexual history of their patients and should be prepared to recognise oral and systemic manifestations of sexually transmitted infections.

We report the first case of drug rash with eosinophilia and systemic symptoms (DRESS) following strontium ranelate (SR) treatment associated with systemic human HHV-7 reactivation. DRESS syndrome is a severe adverse drug-induced reaction presenting as a diffuse maculopapular skin rash with fever, hematological abnormalities (leukocytosis, eosinophilia, and/or atypical lymphocytosis), and multiorgan involvement. In our patient, diagnosis of DRESS was confirmed by the presence of six of the seven diagnostic criteria established in 2006 by the Japanese Research Committee on Severe Cutaneous Adverse Drug Reaction: maculopapular skin rash developing at least 3 weeks after starting therapy with a limited number of drugs, prolonged clinical symptoms after discontinuation of the causative drug, lymphadenopathy, fever, leukocyte abnormalities, and liver abnormalities. The diagnostic criteria of human herpesvirus (HHV)-6 reactivation have not been fulfilled in our patient, but a HHV-7 active infection was demonstrated by the presence of HHV-7 DNA and IgM in the patient's serum. In fact, in some DRESS instances, reactivation of HHVs other than HHV-6 may be detected, including HHV-7, Epstein-Barr virus (EBV), and cytomegalovirus (CMV). Our case underlines that not only HHV-6 but also HHV-7 systemic reactivation may be associated with a more severe and even fatal course of this syndrome.

Background Adverse cutaneous drug reactions (ACDR) are unexpected cutaneous changes occurring at drug dosages that are normally used for disease prophylaxis, diagnosis or treatment. Objective The aim of the study was to determine the clinical types of ACDR, the causative agents, the latency time between drug intake and onset of ACDR and the recovery time in an outpatient population.Method Ninety-five patients diagnosed with ACDR at the Department of Dermatology of the University of Genoa between 2003 and 2012 were retrospectively studied. Results Antimicrobials, especially cephalosporins, were the most responsible for ACDR, followed by non-steroidal anti-inflammatory drugs and antihypertensives. The most common clinical manifestations were exanthema (42.1 %), erythema multiforme (10.53 %) and vasculitis (9.53 %). Patients with peripheral eosinophilia showed a more severe clinical manifestation, they were treated with systemic therapies and their recovery time was longer. Conclusion It is important to have an appropriate clinical approach according to the ACDR severity degree. We think that eosinophilia may characterise severe cutaneous eruptions and that it should always be investigated when ACDR is suspected in order to manage the patient with the appropriate treatment.

Background Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare syndrome consisting of acute symmetrical tenosynovitis of the hands and wrists associated with pain and marked pitting edema of the dorsum of the hands or the feet. Persistent rheumatoid factor seronegativity and elevated acute phase reactants are the rule, while radiographic findings are characterized by the absence of bony erosions. The syndrome has occasionally been associated with a wide range of diseases including solid and hematological malignancies, polymyalgia rheumatica, and other inflammatory rheumatic diseases. Methods Two patients with skin eruption on hands and feet associated with arthromyalgias have been investigated to confirm diagnosis of RS3PE and to detect comorbidities. A revision of all the possible medical conditions correlated to RS3PE has been performed. Results We report two cases of RS3PE associated with Parvovirus B19 infection/reactivation. There are very few reports on the association between RS3PE and infectious agents, and in only one case the syndrome has been correlated to parvovirus infection. Conclusions We want to underline the importance for patients with RS3PE to be seen by dermatologists who should become familiar with this syndrome and remark that Parvovirus B19 infection may be a potential cause of RS3PE.