Giovanni Damiani

Exhaled Nitric Oxide as a Biomarker in COPD and Related Comorbidities

Chronic Obstructive Pulmonary Disease (COPD) is defined as a disease characterized by persistent, progressive airflow limitation. Recent studies have underlined that COPD is correlated to many systemic manifestations, probably due to an underlying pattern of systemic inflammation. In COPD fractional exhaled Nitric Oxide (FeNO) levels are related to smoking habits and disease severity, showing a positive relationship with respiratory functional parameters. Moreover FeNO is increased in patients with COPD exacerbation, compared with stable ones. In alpha-1 antitrypsin deficiency, a possible cause of COPD, FeNO levels may be monitored to early detect a disease progression. FeNO measurements may be useful in clinical setting to identify the level of airway inflammation, per se and in relation to comorbidities, such as pulmonary arterial hypertension and cardiovascular diseases, either in basal conditions or during treatment. Finally, some systemic inflammatory diseases, such as psoriasis, have been associated with higher FeNO levels and potentially with an increased risk of developing COPD. In these systemic inflammatory diseases, FeNO monitoring may be a useful biomarker for early diagnosis of COPD development.

Autoinflammatory Disease Damage Index (ADDI): a possible newborn also in hidradenitis suppurativa daily practice

To the Editor: Ter Haar et al 1 report a new tool, Autoinflammatory Disease Damage Index (ADDI), to measure damage caused by autoinflammatory diseases. Although this preliminary instrument was for patients with familial Mediterranean fever, cryopyrin associated periodic syndrome, tumour necrosis factor receptor-associated periodic fever syndrome and mevalonate kinase deficiency, we found a great utility also in another …

Liver Illness and Psoriatic Patients

Psoriasis is a chronic inflammatory disease of the skin affecting approximately 2% of the worlds population. Systemic treatments, including methotrexate and cyclosporin, are associated with potential hepatotoxicity, due to either direct liver damage or immunosuppression or both immunomediated and a direct liver injury; therefore, treatment of patients with psoriasis poses a therapeutic challenge. The aim of this minireview is to help clinicians in the management of psoriatic patients who develop signs of liver dysfunction. To find relevant articles, a comprehensive search was performed on PubMed, EMBASE, and Cochrane with appropriate combinations of the following keywords being considered: viral hepatitis, nonalcoholic fatty liver disease, psoriasis, hepatotoxicity, drug toxicity, cholestasis, and autoimmune liver diseases.

Outcomes assessment of hepatitis C virus-positive psoriatic patients treated using pegylated interferon in combination with ribavirin compared to new Direct-Acting Antiviral agents

AIM To evaluate the outcomes in biological treatment and quality of life of psoriatic patients with chronic hepatitis C (CHC) treated with new Direct-Acting Antiviral agents (DAAs) compared to pegylated interferon-2α plus ribavirin (P/R) therapy. METHODS This is a retrospective study involving psoriatic patients in biological therapy who underwent anti-hepatitis C virus (HCV) treatment at the Department of Dermatology Galeazzi Orthopaedic Institute Milan, Italy from January 2010 to November 2017. The patients were divided into two groups: patients that underwent therapy with DAAs and patients that underwent HCV treatment with P/R. Patients were assessed by a dermatologist for psoriasis symptoms, collecting Psoriasis Area Severity Index (PASI) scores and the Dermatology Quality of Life Index (DLQI). PASI and DLQI scores were evaluated 24 wk after the end of HCV treatment and were assumed as an outcome of the progression of psoriasis. Switching to a different bDMARD was considered as an inadequate response to biological therapy. The dropout of HCV therapy and sustained virological response (SVR) were considered as outcomes of HCV therapy. RESULTS Fifty-nine psoriatic patients in biological therapy underwent antiviral therapy for CHC. Of this, 27 patients were treated with DAAs and 32 with P/R. After 24 wk post treatment, the DLQI and the PASI scores were significantly lower (P < 0.001 and P < 0.005, respectively) in the DAAs group compared with P/R group. None of the patients in the DAAs group (0/27) compared to 8 patients of the P/R group (8/32) needed a shift in biological treatment. CONCLUSION DAAs seem to be more effective and safe than P/R in HCV-positive psoriatic patients on biological treatment. Fewer dermatological adverse events may be due to interferon-free therapy.

A mysterious abdominal pain during active psoriasis

and subsequently treated, and viral gastroenteritis. In each reactivation, hepatitis viruses A, B, C, EBV and HIV were excluded because of blood cultures and negative serology. Urine cultures were negative too. She displayed some comorbidities, namely, anxious-depressive syndrome, bulimia, and arterial hypertension. She was also vaccinated with Calmette Guérin bacillus. The current treatment for psoriasis was acitretin 30 mg daily; however, she failed several therapies, namely, methotrexate for lack of efficacy, cyclosporin for renal toxicity, adalimumab for recurrent fever, and ustekinumab for toxiallergic exantema. The actual presentation was dominated by several erythematous and hyperkeratotic plaques with a severe infiltration, mainly located to the trunk, scalp and in the palmo-plantar area. In the context of these plaques, numerous sterile and confluent pustular elements enriched the medical findings (Fig. 1). Psoriasis Area Severity Index (PASI) was 60 and body surface area (BSA) was 93%, delineating a very severe disease. Vital signs, namely, blood pressure 146/94 mmHg, heart rate of 96 beats/min, and 99% oxygen saturation in room air, were collected and depicted a stable patient. Physical examination revealed distended, not swelled, symmetric abdomen, with generalized pain and tenderness to palpation. There was no palpable liver or spleen. Murphy, Blumberg and Rovsig signs were all negatives. Charcot’s triad was not present. Auscultation revealed sparse obtunded bowel sounds, no tinkles, and no umbilical bruits. Percussion produced tympanic sounds.

Values in Elderly People for Exhaled Nitric Oxide Study.

Ageing population is constantly increasing due to rising life expectancy; consequently, the percentage of the elderly patients with asthma is increasing, as well. Fractional exhaled nitric oxide (FeNO) is a biomarker of lung inflammation, and currently it is widely used in clinical practice for asthma diagnosis and monitoring. Yet, there are no data about normal values of FeNO in patients of more than 65 years of age with normal lung function. The aim of this study was to establish adult FeNO reference values for subjects older than 65 years, according to the international guidelines. FeNO was measured in 303 healthy, nonsmoking adults more than 65 years of age, with normal spirometry values measured using the online single-breath technique. The results were analyzed by chemiluminescent detection. The FeNO levels obtained range from 5.00 to 29.9 ppb, with a mean value of 12.48 ± 2.80 ppb. A significant association of FeNO levels with age (p < 0.05) was observed. There was no difference in FeNO values between men and women unlike what was observed in younger patients. FeNO levels in healthy controls over 65 years of age are influenced by age as in younger adults. However, there is no difference in FeNO values in male and female seniors, in contrast with what was found in younger adults in other studies. These data can be useful for the clinician to interpret the values of FeNO assessed during clinical practice.

Diagnosis of right-sided varicocele: A retrospective comparative study between clinical examination, Doppler findings, US imaging and vascular anatomy at phlebography

Historically varicocele is diagnosed almost exclusively on the left side. The introduction of new imaging techniques has allowed the identification and characterization of right varicocele. This study aims to compare the diagnostic accuracy of various imaging techniques to data obtained using phlebography in the diagnosis of right varicocele. Patients treated for isolated right varicocele between 1992 and 2010 were retrospectively identified. Data from clinical examination, Doppler-USS, Color-Doppler-USS and Retrograde Phlebography were collected for each patient. 133 out of 4305 patients (3.1%) presented with an isolated right varicocele. 34 of these patients (25.6%) presented with palpable right varicocele. Doppler-USS identified various degrees of type I right venous reflux in 90 patients (67.7%). Phlebography showed venous reflux in all the patients (133), although with variability in terms of internal spermatic vein anatomy. Right varicocele is characterized by predictable anatomic features. Identification and characterization of these features is useful in guiding percutaneous treatment, allowing to optimize radiological display and reducing failure rate.

Benchmarking Stem Cells and Transplantation in Psoriasis

Psoriasis is a chronic systemic inflammatory disease with several abnormalities in hematopoiesis. During the last 30 years, stem cell science was intensively studied, also in the field of psoriasis, to discover therapeutic modalities by reversing the unbalance in lymphopoiesis. In fact, available results in literature have reported psoriasis remission after stem cell transplantation. The present review summarizes the current knowledge on psoriasis, stem cells and transplantation.

Saliva as a Future Field in Psoriasis Research

Psoriasis is a skin inflammatory disease characterized by an increased body of comorbidities, including parodontopathy. Despite the visibility of skin lesions, prognostic biomarkers, related to disease monitoring and therapeutic effectiveness, are still missing. Although several markers have been studied, none of them has been identified as an independent prognostic factor. This concise review aims to summarize the current knowledge and results in saliva research applied to psoriasis. Combination of different markers could improve the prognostic prediction in patients with psoriasis. Future studies are needed to implement research on salivary biomarkers and their prognostic/therapeutic effects in the management of patients with psoriasis.

A unique pneumopathy in a patient with skin nodules and abscesses

A 34-year-old man was referred to the Department of Dermatology of our hospital because of a presumed diagnosis of perianal Crohn’s disease. Medical history was positive for severe acne, while there was no positive family history for either inflammatory bowel diseases or allergies. On physical examination, the patient was apyretic, with a blood pressure of 132/86 mmHg, heart rate of 76 beats/ min, 17 breaths/min, 97% oxygen saturation in room air. He reported a mild dyspnea occurred 1 month before, with Valleix points examination negative; however, auscultation revealed some crackles prevalently in the bases. Dermatological assessment showed multiple deep-seated inflamed nodules, fistulas and bridging scars on armpits and perianal area with scrotal involvement (Fig. 1). Laboratory investigations demonstrated an increased erythrocyte sedimentation rate (76 mm/h; range 20–50 mm/h); C-reactive protein was also elevated (18 mg/L; range 0.2–5 mg/L). Urine examination, procalcitonine and quantiferon-tests were negative. Therapy was initially azithromycin 500 mg daily for 3 consecutive days weekly for 6 weeks. At the same time, the dyspnea was also evaluated.